Oncology & Hematology Coding Alert

The difference between nasopharyngo and laryngoscopy is big bucks

In addition to knowing the right "scope" code, you may need to report it properly with an E/M visit to recoup the payment your practice deserves.

Radiation oncologists frequently perform a nasopharyngoscopy (92511) or laryngoscopy (31575) to examine "how the patient is responding to treatment and whether he's having any radiation complications," says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.

If you know your anatomy and use common medical sense, you will assume that a nasopharyngoscopy involves insertion of the scope through the patient's nose, and the laryngoscope involves an oral scope insertion. And if you apply this understanding when you read your oncologist's notes, you probably choose a code based on where the physician inserted the scope.

This information is not, however, the key to assigning the correct code. The key is what anatomic area (nasopharynx or larynx) the oncologist examines with  the scope.

Source of confusion: Sometimes physicians will choose to perform a nasal scope insertion for a laryngoscopy because inserting the scope through the patient's nose is easier than making the patient hold his mouth open for a long time, says Tom Colletti, MPAS, PA-C, with Duke Medical Center in Durham, N.C. So if you read "nasal scope insertion" in your physician's documentation and assume he performed a nasopharyngoscopy, you could be jumping to an incorrect conclusion.

Solution: Read your oncologist's documentation very thoroughly to discern what anatomic part he examined with the scope procedure - this fact should guide your code selection. Remember that 92511 reimburses higher than 31575 in the nonfacility setting, so choosing the correct code has significant meaning for your bottom line, says Mary Tait, CPC, with Amerimed Billing & Consulting in Pocatello, Idaho.

For example, if the documentation states the physician performed a nasal scope insertion and examined the patient's larynx, you would report 31575 for the procedure.

Use -25 for Same-Day Scope and E/M

After you determine the correct scope code to report, you need to know whether you can bill for a same-day E/M service if your oncologist performs one. You can't always bill for an E/M on the same day as 92511 or 31575, Tait says. To code for both services, you must have documentation that supports the medical necessity and the separate and distinct nature of the two services.

You must also append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code you report.

For example, oncologists often make a same-day decision to perform a laryngoscopy. A patient may present for a completely separate problem, and after the oncologist provides the E/M service he may decide a laryngoscopy is necessary. In this case, you can bill for both the E/M (with modifier -25) and 31575 as long as the physician's documentation clearly explains the distinct reason for the laryngoscopy. And the physician should provide a separate procedure note for the laryngoscopy so you have documentation that both services are separate and distinct.

Not OK: You cannot bill for both the E/M and 31575 if the patient comes in specifically for a laryngoscopy and the physician only takes the patient's vital stats but doesn't perform a full and separate E/M.