You can only report 92504 in this circumstance. You know you should include tube removals as part of the E/M visit code, but you can encounter circumstances when you can report separate services. Check out the following three instances in which tube removal demands coding above and beyond a simple E/M service. Bundle Removal to E/M -- Usually In most cases, you should consider ear tube removal to be a component of any E/M service the ENT provides during the same visit. Assign E/M with caution: What NOT to do: Case 1: Tympanic Repair If the ENT must perform a tympanic repair (or so-called "paper patch") as a result of the tube removal, you may report this procedure separately using 69610 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch), Cobuzzi says. If you report 69610, you would not likely report an E/M code in addition unless your ENT documents a significant and separately identifiable E/M service. If documentation supports such a service, however, be sure to append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the appropriate E/M service code. Case 2: Microscope Use If the ENT must use a binocular microscope to aid in tube removal, you may report 92504 (Binocular microscopy [separate diagnostic procedure]). Remember: Example: Case 3: Removal in OR When the surgeon removes tubes in the OR under general anesthesia after the 10-day global associated with 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia) expires, you will report 69424 (Ventilating tube removal requiring general anesthesia) with no modifier appended. An important point: Tube removals during the global period of 69436 that do not require a return to the OR are bundled with the tympanostomy. You may not report these services separately. The only exception is if the physician removing the tubes is not the same physician who placed the tubes (or a member of that physician's group practice). If your physician removes tubes placed by another group practice, you can report an E/M service (as explained above), even if the removal occurs in the office during the 10-day global period of 69436 since the global does not apply to your physician.