Otolaryngology Coding Alert

 You can capture tymp-related care without using a modifier

You can ethically capture hearing test reimbursement during a multiple surgery follow-up visit if you follow this rule: Report exams that don't relate to the existing surgical package.
 
The July 2004 Otolaryngology Coding Alert reader question "Modifier -24 Unlocks Unrelated E/M Pay" addressed reporting a myringotomy within an appendectomy's global period. The subscriber, however, asked about coding a bilateral myringotomy with tubes and an adenoidectomy.
 
Otolaryngologists typically perform typanostomies (myringotomy with tubes) (69433-69436) and adenoidectomies (42830-42836) together. Unless an otolaryngologist has a duel specialty, such as ENT and general surgery, he would not remove a patient's appendix. Therefore, the reader question should have stated:
 
Question: I performed bilateral myringotomy with tubes (10 global days) and an adenoidectomy (90 global days). I saw the patient for a postoperative visit and audiogram three weeks later. How should I code the visit and audiogram?
 
Answer: You should bill only the audiogram. When reporting procedures during a global surgical period, claim only unrelated services.
 
In your scenario, the adenoidectomy (42830-42836, such as 42830, Adenoidectomy, primary; under age 12) triggered the global period. The E/M presumably relates to the adenoids and the tubes. So you shouldn't bill an E/M code for the service. To track your follow-up work, instead report nonpaying code 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure).
 
Because the audiogram relates to the tympanostomy (69433, Tympanostomy [requiring insertion of ventilating tube], local or topical anesthesia; or 69436, Tympanostomy [requiring insertion of ventilating tube], general anesthesia) whose postoperative period expired, you should report the 69433-69436-related service with the appropriate audiogram code (such as 92557, Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556 combined]).
 
Remember, you don't need to append a modifier to the audiogram code. It doesn't relate to the existing postoperative period.