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A Comprehensive Guide to Otolaryngology Medical Billing

Let’s contradict the common belief that Otolaryngology is more than just an everyday, casual practice. The major thing to consider is that it is a lot more than simple ENT procedures, i.e. ‘ear, nose and throat’ practices. In the current fast-paced world, an independent otolaryngology practitioner would have to take care of several things.

As technology is moving at a fast pace, most independent Otolaryngology practices and hospitals are trying to streamline the complexities related to coding management and accurate medical billing. This sometimes leads to overlooking crucial operations. The frequent alterations that are being made in ICD 10 are also one of the significant reasons why it is essential to give utmost care to the changes brought in the billing procedures and coding requirements.

The most crucial thing to do is to take care of the everyday processes by the staff that are undertaken at the Otolaryngology clinic on a regular basis. The process of revenue collection, the billing process as well as the constantly changing scenario can sometimes make everything quite tedious.

To streamline the billing processes and improve efficiency, Otolaryngologists are increasingly adopting innovative technologies and strategies. In this blog, we will explore some of the key trends in otolaryngology billing and see how the medical billing specialists like – Eminence RCM can help otolaryngology practices in leveraging innovation for efficiency.

Otolaryngology (ENT) coding is not just about memorizing different sets of codes and modifiers, but it is much more than that. It is important to use them regularly for different bills and claims. The CPT codes in Otolaryngology highly depend on the coder’s ability to properly understand the documentation process provided by the Otolaryngologists. If every challenge in the process is properly understood, it becomes easier to tackle them and the billing errors can be reduced to a minimum.

Let’s Understand Common Otolaryngology (ENT) Coding Mistakes

Inability to Understand the Anatomy of Otolaryngology

It is obvious that physicians can perform procedures in various sinuses (e.g., sphenoid, frontal, maxillary, and ethmoid). The duty of the coders here is to understand how to code procedures on each of those sinuses. For this, coders need a strong understanding of anatomy within coding otolaryngology procedures. Therefore, the coders who lack knowledge of ENT anatomy, can’t perform the procedures easily and correctly.

It is important for the coders to carefully read the documentation and choose the most suitable code or codes for the particular procedure. A well-trained coder is the one who is able to identify the sinuses with the help of the anatomical location mentioned by the surgeon and accurately assign the codes.

Selection of Wrong Codes

While coding endoscopic sinus surgeries, coders can run into various trouble spots. For instance, coders most frequently miscode maxillary antrostomy by reporting CPT code 31267 (nasal/sinus endoscopy, surgical, with the removal of tissue from maxillary sinus). The right code to use is 31256 (nasal/sinus endoscopy, surgical, with maxillary antrostomy).

For coders to report code 31267, it is important for the physicians to remove ‘tissue’ (e.g., polyps, fungus ball, mucocele) within the maxillary sinus. The physician must remove the tissue from within the maxillary sinus not around the opening of the maxillary sinus.

Not able to Understand Notes

It is important for the coder to go through the notes thoroughly. If a coder does not deeply go through the notes of the entire procedure, there is a high possibility that the person is sure to miss important information and assign the wrong CPT codes for ENT procedures. The sole purpose of the summaries is only to describe the procedure in a nutshell. They can’t do justice to the entire process including complications or health concerns that the patient might have identified.

In ICD-10, there are more than 85,000 CPT codes that are needed to report different medical procedures, visits, or different examinations. More codes are added to increase the depth with which patient records are maintained. The inability of coders to understand notes can greatly affect the choice of CPT codes for reporting a certain procedure and add complications to the process of medical billing.

Balloon Sinuplasty Procedures

A relatively new procedure called balloon sinuplasty can be used by Physicians to open inflamed sinuses in patients who don’t respond to the medication. The actual coding for the procedures is easy because the codes are straightforward. However, the problem is that there are various payers who do not reimburse for these procedures. Therefore, all the coders are reluctant to use the ballon dilation codes. No matter how simple the codes are, there is a high chance that the coders can still get trapped in the physical documentation. Especially if the coders don’t pay attention to the details and only read the summary at the start of the operative report.

How is Outsourcing a Right Choice in Otolaryngology

Due to lots of altercation in Otolaryngology billing and coding many healthcare facilities have chosen to outsource their ENT billing and coding requirements with an efficient partner like Eminence RCM. The major thing to take care of is that the company must specialize in otolaryngology coding and billing services.

Let’s look at the different ways how outsourcing medical billing services can help your Otolaryngology practice:

Accuracy in processes

For Otolaryngology billing, when you work with a team of specialists, you will eventually be able to reduce the number of charging errors within your accounts. The reason is that the ENT billing and coding staff takes your billing and coding as a priority. Their primary focus is to keep up with the latest coding requirements and procedures to provide the healthcare providers with the best medical billing services. There is a team with the latest training and support to properly submit your medical claims. This will eventually help to reduce errors and improve accuracy. And most importantly, it plays a vital role to maximize reimbursements and boost cash flow for your healthcare practice.

An Efficient and Trained Staff

You might have difficulties making sure whether your staff has enough time every day to take care of patients and keep up with ENT billing and coding. This is where outsourcing might prove to be the best option. Before choosing an Otolaryngology medical billing partner, have a look at your time management issues right from the front desk staff all the way to the back offices. When you outsource your medical billing services, it can provide you with a complete analysis and help you find better ways to manage time and create a more efficient and effective atmosphere.

Compliance is Taken Care Of

One of the issues faced by various healthcare practices these days, which is worth noting, is guaranteeing billing compliance. The reason might be that the healthcare industry has experienced so many frequent changes in recent years that ENT billing and coding staff are undertrained. Because of the ICD transition, many practices are set back. This results in rejected or denied claims due to billing errors. Outsourcing ENT billing can be a very good solution that can help your staff get back on track. It also helps to streamline administrative tasks to ensure compliance with industry regulations and billing practice

Positive Revenue Flow

One of the main advantages of third-party billing companies is the reduction in overhead costs because of the savings for in-house staff, supplies, computers, training, and more. Despite these advantages revenue can still be increased with timely submission of medical claims, resulting in improved reimbursements. With proper coding, the certainty of a higher profit increases. This prevents your practice from ‘leaving money on the table’ because of coding errors.

When you are a growing, new, or hustling otolaryngologist, your ultimate idea is to focus on patient care. Therefore, your foremost priority is to look for ways of how to flourish your healthcare practice. The best way to overcome the time constraint and reduce overhead expenses is to outsource your ENT medical billing services to professionals like Eminence RCM.

In this highly unpredictable environment, outsourcing medical billing tasks seems like a loss of control for some medical practices. But if you choose your medical billing partner wisely, outsourcing the medical billing process can enhance your control over billing processes. The results will be increased profits, productivity, and patient satisfaction.

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