QUESTION:
When a total thyroidectomy is done, the parathyroid is usually explored and sometimes removed. The question is if the parathyroid is explored or examined, but then not removed, can this procedure be counted as a parathyroidectomy??

ANSWER:
I believe it should not be coded as such. Parathyroids are commonly seen in a thyroidectomy, but the parathyroidectomy code assumes the proper workup has been accomplished pre-operatively and that the approach is primarily for parathyroid removal. Otherwise, almost every thyroidectomy could utilize the parathyroidectomy code.

QUESTION:
PIF Supplement 2 Institutional Operative Data. Includes data on procedures done by residents and faculty. Is this ONLY those cases performed by both or may it also include cases performed by faculty only?

ANSWER:
It is both as the RRC wants to review the total number of cases from the Otolaryngology service.

QUESTION:
Our residents go to Guatemala for two weeks during the PGY-4 year. Can we count the operative procedures done in Guatemala or any out of country rotation?

ANSWER:
The RRC will not accept operative procedures done out of the country for the following reasons. There is no mechanism for assurance of appropriate pre and postoperative care that may include pre and post hospital continuity of care. In addition there may be inadequate supervision as well as the inability to comply with the appropriate duty hour regulations and the working environment. There is no assurance of appropriate mechanisms to evaluate the residents by the attending and no mechanism for the residents to evaluate the experience. Typically, there would not be an affiliation agreement with routine assurance that the conditions related to resident support, benefits and insurance are in compliance with the Institutional Requirements.

QUESTION:
How should the residents code for procedures that include two major components, such as tympanoplasty with ossicular reconstruction?

ANSWER:
For example, to get credit for both the tympanoplasty and the ossicular reconstruction, the resident will need to enter the CPT code twice in the System.  Even though the code description may indicate that the procedure was both components, because the Review Committee has split them out into two different categories, the resident must enter the code twice to get proper credit. If the resident is doing just a mastoidectomy, he or she should enter mastoidectomy.  If resident does only a tympanoplasty, he or she should just enter tympanoplasty.  If the procedure includes an ossicular reconstruction, tympanoplasty and mastoidectomy, then the resident enters the CPT three times.

QUESTION:
CPT codes are bundled codes. Yet the RRC is asking for unbundling of codes for coding purposes only. Will you explain this area further?

ANSWER:
There are bundled CPT codes for operative procedures, for example, that include, for example, both a tympanoplasty and mastoidectomy.  While these are the correct codes for billing, the Committee has determined that they want the residents to unbundle these codes and enter separate codes for example, tympanoplasty and mastoidectomy for recording of operative data in ADS

QUESTION:
With the new category of "resident supervisor" are those who mark this code given as much "credit" as those who are listed as "resident surgeon"?

ANSWER:
No. The RRC is interested primarily in the number of cases done as surgeon and assistant. The program requirements call for a progressive experience for all residents and the RRC looks for evidence that the program is meeting this requirement. The role of resident surgeon is important for the Chief year and evidence of the residents’ competency to supervise others is a necessary component of resident education.

QUESTION:
Is it possible to count the number of cases the resident does in the first year of the residency education and enter them in the case log system?

ANSWER:
Yes, residents can count and record the number of otolaryngology procedures only during the first year. The resident can choose to keep a record of all procedures but for the purposes of the Committee, only the otolaryngology procedures should be entered into the data system.