Tabaee Abtin, Riley Charles A, Brown Seth M, McCoul Edward D
1 Department of Otolaryngology, Weill Cornell Medicine, New York, New York.
2 Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine, Farmington, Connecticut.
Am J Rhinol Allergy. 2018 Jul;32(4):330-336. doi: 10.1177/1945892418773570. Epub 2018 May 7.
Introduction Nasal endoscopy (NE) is an essential element of office-based clinical rhinology, including the evaluation of chronic rhinosinusitis. Despite the presence of guidelines, variability exists regarding coding and billing for NE especially with regard to inclusion of evaluation and management (E&M) codes and use of the 25 modifier. The goal of this survey was to assess the billing patterns for NE among American Rhinologic Society (ARS) members. Methods An invitation to participate in a web-based survey was electronically sent to all ARS members. Survey participants were queried regarding demographics and billing patterns for NE in several different clinical scenarios using a 5-point Likert-type scale, with a score of 5 representing "always" and a score of 1 representing "never" for billing E&M. Results A total of 93 respondents successfully completed the survey with a range of the number of years since completing training, practice type (50.5% private, 44.1% academic) and completion of a rhinology fellowship (40.9%). Variable responses for billing patterns for distinct clinical scenarios were noted. Higher scores for billing both E&M and NE for the queried clinical scenarios were noted for new patients (mean 4.50) compared to established patients (mean 3.81) and postoperative patients (mean 3.04). Inclusion of a septoplasty as part of the surgery impacted billing an E&M code 28% of the time. Practice type and history of performing a fellowship did not significantly influence billing patterns for NE. Conclusions Significant variability exists among ARS respondents with regard to billing patterns for NE, despite the presence of coding guidelines. Additional teaching of standard coding practices for NE may limit variability among otolaryngologists.
引言 鼻内镜检查（NE）是门诊临床鼻科学的重要组成部分，包括对慢性鼻-鼻窦炎的评估。尽管有相关指南，但在NE的编码和计费方面仍存在差异，尤其是在评估与管理（E&M）编码的纳入以及25修饰符的使用方面。本次调查的目的是评估美国鼻科学会（ARS）成员中NE的计费模式。方法 以电子方式向所有ARS成员发送参与基于网络调查的邀请。使用5点李克特量表询问调查参与者在几种不同临床场景下NE的人口统计学和计费模式，对于E&M计费，5分表示“总是”，1分表示“从不”。结果 共有93名受访者成功完成调查，其完成培训后的年限、执业类型（50.5%为私立，44.1%为学术）和鼻科学 fellowship完成情况（40.9%）各不相同。注意到不同临床场景下计费模式的不同回答。与复诊患者（平均3.81分）和术后患者（平均3.04分）相比，新患者在询问的临床场景中E&M和NE计费得分更高（平均4.50分）。鼻中隔成形术作为手术一部分时，有28%的时间会影响E&M编码计费。执业类型和完成fellowship的经历对NE的计费模式没有显著影响。结论 尽管有编码指南，但ARS受访者在NE计费模式方面存在显著差异。对NE标准编码实践的额外教学可能会减少耳鼻喉科医生之间的差异。
