# Microscopy and E/M same date



## jaldrich

I have a new ENT starting up, and he's billing 92504 on almost all the patients.  He is seeing the patients for a consult for ENT problems, and sometimes performing a cerumen impaction removal (69210) as well.  Is it appropriate to bill 92504 as well on these visits?  

It seems that 92504 would be included in the E/M coding, but the CPT book says 

"Diagnostic or treatment procedures usually included in a comprehensive otorhinolaryngologic evaluation or office visit, are reported as an integrated medical service, using appropriate descriptors from the 99201 series.  Itemization of component procedures (eg, otoscopy, rhinoscopy, tuning form test) does not apply.  
Special otorhinolaryngologic services are those diagnostic and treatment services not usually included in a comprehensive  otorhinolaryngologic evaluation or office visit.  These services are reported separately, using codes 92502-92700."

What do people think about this? 
Thanks!


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## coder911

Hi,

After reading the paragraph preceding 92504 titled "Special Otorhinolaryngologic Services", I would code 92504 as a seperate service. I would also code the 69210 as long as you have that seperate dx to support it. I also read in an article from "Family Practice Coding Alert" that the ear irrigation dictation must also indicate that an instrument was used in addition to the flush to remove the cerumen. Something I wasn't aware of.


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## b.cobuzzi

If your doctor uses the binocular microscope for every EM, it seems that he/she is using it as part of the exam and it is not separately billable.  There has to be a reason to use it, in order to separately bill it.

Although 92504 has xxx global days (no global definition), cci 7.2 added the definition of a minor em as being part of xxx globals.  So, if the em is a significantly separately identifiable em service from 92504, you can put a 25 modifier with the em with the 92504.

Finally, removal of impacted cerumen is a separate procedure, meaning that anything else done in the ear is considered incidental to the removal of the cerumen, meaning that the binocular microscopy is included.  Similarly, 92504 is also a separate procedure, meaning that anything else done in the ear is incidental to the microscope.  So, one or the other can be charged, not both.  Also, as you read, yes, 69210 must require substantial physician skill and instruments, such as forcepts, curettes, etc.


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## Kevinph84

b.cobuzzi said:


> If your doctor uses the binocular microscope for every EM, it seems that he/she is using it as part of the exam and it is not separately billable.  There has to be a reason to use it, in order to separately bill it.
> 
> Although 92504 has xxx global days (no global definition), cci 7.2 added the definition of a minor em as being part of xxx globals.  So, if the em is a significantly separately identifiable em service from 92504, you can put a 25 modifier with the em with the 92504.
> 
> Finally, removal of impacted cerumen is a separate procedure, meaning that anything else done in the ear is considered incidental to the removal of the cerumen, meaning that the binocular microscopy is included.  Similarly, 92504 is also a separate procedure, meaning that anything else done in the ear is incidental to the microscope.  So, one or the other can be charged, not both.  Also, as you read, yes, 69210 must require substantial physician skill and instruments, such as forcepts, curettes, etc.



I agree 92504 and 69210 is considered unbundled, when coded seperately. It is either one of the other not both.


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## Candice_Fenildo

I agree with Barb. I have had to jumo these hurdles with my new Doc. I am sendnig him to the E/M conference in Orlando, and my ARNP to the one in tampa.

I hope they pick up a little knowledge out of it.


Candice Ruffing, CPC
Drs Berghash & Lanza P.L.
cruffing@otodocs.com


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