Procedure-Specific Billing
Specialized Billing for Every ENT Service
Each ENT service type carries its own NCCI edit exposure, modifier requirements, and payer documentation standards. ProtoMed's certified team handles every service correctly, preventing the bundling conflicts, modifier omissions, and code selection errors that cost ENT practices revenue on every encounter.
Nasal Endoscopy Billing
Nasal endoscopy coding requires correct identification of whether the procedure is diagnostic or operative, which nasal passage was examined, and which therapeutic interventions were performed during the same session. Sinusotomy, polypectomy, and tissue removal add-on codes must be applied correctly alongside the primary endoscopy code, and NCCI edits determine which combinations can be billed separately. We accurately code every nasal endoscopy encounter and apply modifier -59 to defend separately billable procedure combinations.
FESS Billing
Functional endoscopic sinus surgery is billed by sinus system, each of the frontal, maxillary, ethmoid, and sphenoid sinuses is coded separately, and bilateral procedures require the -50 modifier. Under-selecting sinus codes means underpayment; over-selecting without documentation is a compliance risk. We select the correct FESS code for every sinus system operated on, apply bilateral modifiers accurately, and ensure the operative report documents each sinus system addressed to support every billed procedure.
Cerumen Removal & Ear Procedure Billing
Medicare requires specific documentation for cerumen removal (CPT 69210): the provider must document that impaction was present and that instrumentation was used to remove it. Lavage-based removal uses a different code (CPT 69209) with its own documentation requirements. Billing 69210 without the correct documentation results in automatic denial. We verify cerumen removal documentation on every claim and correctly distinguish between instrumentation-required and lavage-based procedures before each claim is submitted.
Tonsil, Adenoid & Throat Procedure Billing
Tonsillectomy and adenoidectomy billing uses age-stratified codes: CPT 42820 for patients under 12 and CPT 42825 for patients 12 and over. When only a tonsillectomy or only an adenoidectomy is performed, distinct codes apply. Post-operative hemorrhage control requires specific CPT codes based on setting and technique. We apply the correct age-based and procedure-specific codes for every throat procedure and manage global period billing for post-operative care.
Allergy Testing & Immunotherapy Billing
Allergy services involve a two-part billing structure: the professional service (physician supervision and interpretation) and the technical service (allergen preparation and injection administration). Allergy testing codes require correct dose sequencing for percutaneous and intradermal tests, and allergy immunotherapy billing tracks the number of doses administered per visit. We accurately bill every component of your allergy service line, ensuring professional and technical components are correctly separated and coded.
Same-Day E/M & Procedure Billing
ENT practices frequently perform in-office procedures, nasal cauterization, cerumen removal, laryngoscopy, and minor surgical procedures, during visits that also involve evaluation and management. Modifier -25 must be applied to the E/M code on every encounter where a same-day procedure is also billed, and the documentation must clearly support the E/M as a separately identifiable service. We apply modifier -25 compliantly on every qualifying encounter and provide the documentation review needed to defend every E/M claim alongside a same-day procedure.
