Essential Guide to Coding in Otolaryngology

Seth M. Brown, MD, MBA, is a graduate of the University of Connecticut School of Medicine. Prior to medical school he obtained a master's in business administration in health systems administration. He completed his residency at the Albert Einstein College of Medicine and a fellowship at Weill Medical College of Cornell University in rhinology and endoscopic sinus and skull base surgery. Dr. Brown is a clinical assistant professor at the University of Connecticut School of Medicine. He is currently chief of service of otolaryngology at St. Francis Hospital and Medical Center in Hartford, Connecticut, and is the site director at the hospital for the University of Connecticut Residency Program. He is active in the American Rhinology Society as a committee chair for the past seven years, currently serving as the chair of the Patient Advocacy Committee. He also serves the Academy on the CPT/RVU committee. Dr. Brown has published and presented extensively on sinus and endoscopic skull base surgery and has a particular interest in coding, practice management, and resident and fellow education. He currently practices at the Connecticut Sinus Institute, a member of Prohealth Physicians, and serves on their board. ***** Kimberley J. Pollock, RN, MBA, CPC, CMDP, is a consultant with KarenZupko & Associates, Inc. For almost twenty years, she has helped large otolaryngology group practices, as well as academic and solo practices, improve coding, collections, and efficiency. She is an expert in analyzing otolaryngology documentation for accurate coding and in reengineering practices to enhance the reimbursement process. Ms. Pollock has presented seminars and workshops for physicians and their staff on behalf of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), the American Society of Plastic Surgeons, and the American Association of Neurological Surgeons. She has also presented on coding topics for the American Academy of Professional Coders, the North American Skull Base Society, the American Neurotology Society, and the Association of Otolaryngology Administrators. Additionally, she has published extensively on coding and practice management topics. Ms. Pollock is a former otolaryngology nurse and served as administrator in the Department of Otorhinolaryngology at the University of Texas Southwestern Medical Center in Dallas. She was the representative for the AAO-HNS on the clinical practice expert panel-technical group (CPEP-TEG) convened by CMS (formerly HCFA) to redetermine the practice expense portion of RBRVS. She has served on the Board of Directors for the Society of Otorhinolaryngology and Head-Neck Nurses, Inc. (SOHN) and the Ear, Nose and Throat Nursing Foundation. She is the recipient of the prestigious Presidential Citation Award from the SOHN as well as an Honor Award from the AAO-HNS. Ms. Pollock holds a master's of business administration degree from the University of Dallas and a bachelor's of science degree in nursing from the University of Wisconsin. She is also a certified coder through the AAPC and a certified medical documentation Professional (CMDP) through the American Institute of Healthcare Compliance. **** Michael Setzen, MD, is currently in private practice in Great Neck, New York. He is a clinical associate professor of otolaryngology at New York University School of Medicine and adjunct clinical assistant professor of otolaryngology at Weill Cornell University College of Medicine. He is section chief of rhinology at North Shore University Hospital in Manhasset, New York. He is a past president of the American Rhinologic Society (2011-2012) and past chairman of the Board of Governors of the American Academy of Otolaryngology-Head and Neck Surgery (2000-2001). He is recipient of the Board of Governors Practitioner Excellence Award of the American Academy of Otolaryngology-Head and Neck Surgery and the American Academy of Otolaryngology-Head and Neck Surgery Distinguished Service Award. Dr. Setzen has been listed yearly in New York Magazines Best Doctors for twelve of the past fourteen years and Castle Connolly's "America's Top Doctors" for the past fifteen years. He has given more than 250 scientific lectures throughout the United States and worldwide and is author or coauthor of numerous papers (seventy-five in peer reviewed journals) and book chapters. He is presently on the editorial boards of International Forum of Allergy and Rhinology, the American Journal of Otolaryngology, and the Ear, Nose, & Throat Journal. Dr. Setzen's areas of significant academic interest include medical and surgical management of nasal and sinus disease including endoscopic sinus surgery, rhinoplasty, snoring and sleep apnea surgery, reflux, sinus headache, and appropriate CPT coding and advocacy related issues in otolaryngology. **** Abtin Tabaee, MD, is associate professor in the Department of Otolaryngology-Head and Neck Surgery at Weill Cornell Medical College (WCMC). Prior to joining WCMC in 2015, he was associate professor and director of rhinology and endoscopic skull base surgery in the Department of Otolaryngology at Beth Israel Medical Center in New York from 2006 to 2015. As a nationally recognized leader in rhinology, Dr. Tabaee's clinical and academic focus is the management of complex disorders of the paranasal sinuses and skull base. He has published extensively in the field with an active research focus on emerging technologies and surgical outcomes. He is the rhinology volume coeditor of Sataloff's Comprehensive Textbook of Otolaryngology Head & Neck Surgery. He has also been actively involved in research and development of postgraduate rhinology education. He has served on various American Rhinologic Society committees, including codirector of the ARS mentorship program. Dr. Tabaee graduated magna cum laude from Duke University and received his medical degree with honors from Cornell University Medical College. He completed residency in otolaryngology-head and neck surgery at New York Presbyterian Hospital, the combined Columbia-Cornell University training program.

• Foreword by Michael G. Stewart, MD, MPH, FACSForeword by Ronald B. Kuppersmith, MD, MBA, FACS Preface About the Editors Acknowledgments Contributors Section I. Basics of Coding and BillingChapter 1. IntroductionNatalie R. LoopsChapter 2. Navigating the CPT (R) BookTeri RomanoChapter 3. Navigating ICD-10-CM CodesLinda GalocyChapter 4. Health PolicyRichard W. WaguespackChapter 5. Successful Strategies in BillingKaren A. ZupkoChapter 6. Strategic Appeals: Managing Denied ClaimsKimberley J. PollockChapter 7. Legal Issues: Management Strategies and Avoiding PitfallsPatricia S. Hofstra and Alison T. RosenblumChapter 8. Billing Guidelines for Nonphysician Practitioners and Teaching PhysiciansSarah WiskerchenChapter 9. The Office VisitBetsy Nicoletti and Kimberley J. PollockChapter 10. Coding for Hospital CareKimberley J. Pollock and Betsy NicolettiChapter 11. Demystifying ModifiersKimberley J. PollockChapter 12. Billing and Coding for Telehealth VisitsJennifer BellSection II. Office-Based OtolaryngologyChapter 13. Office RhinologySeth M. Brown and Abtin TabaeeChapter 14. Otolaryngic AllergyGavin Setzen and Michelle NetoskieChapter 15. Office LaryngologyJohn W. Ingle and Clark A. RosenChapter 16. Speech PathologyManderly Cohen and Michael SetzenChapter 17. Office OtologyBenjamin J. WycherlyChapter 18. AudiologyDebra AbelChapter 19. Office Facial Plastic SurgerySarah M. Kidwai and Amit D. BhranyChapter 20. Office Head and Neck SurgeryChetan Y. Safi and Marc A. CohenChapter 21. Office Pediatric OtolaryngologyKaitlyn B. Zenner, John P. Dahl, and Sanjay R. ParikhChapter 22. Office Sleep MedicineAnit T. PatelChapter 23. In-Office ImagingGavin Setzen, Mary Lally, and Michelle NetoskieSection III. Surgical OtolaryngologyChapter 24. Basics of Surgical CodingR. Peter Manes and Seth M. BrownChapter 25. Operative RhinologyJustin P. McCormick and Jivianne T. LeeChapter 26. Operative LaryngologyBabak Sadoughi and Lucian SulicaChapter 27. Operative OtologyJames LinChapter 28. Operative Facial Plastic SurgeryJeffrey D. Wilcox and Rebecca E. FraioliChapter 29. Operative Head and Neck SurgeryBetty Y. Chen, Arun Sharma, Pardis Javadi, and Brendan C. Stack, Jr.Chapter 30. Reconstructive Head and Neck SurgeryAdam S. Jacobson, Babak Givi, and Neal D. FutranChapter 31. Skull Base SurgeryBelachew Tessema and Jack A. ShohetChapter 32. Robotic SurgeryJustin R. Shinn, Steven B. Cannady, Bert W. O'Malley Jr., Gregory S. Weinstein, and Jason G. NewmanChapter 33. Operative Pediatric OtolaryngologyJay R. ShahChapter 34. Operative Sleep SurgeryFred Y. LinIndex