Otolaryngology Coding Alert

Secret: Larynx versus nasopharynx makes the difference between 31575 and 92511 Don't give up thousands in E/M service or scope pay because you don't know which CPT codes you can report. Instead, nail down the coding best practices -- and snafus to avoid -- when coding in-office flexible laryngoscopy. Choose 31575, 92511 Based on Anatomy Examined If you-re not sure how to classify a diagnostic scope in the office, you-re not alone. What CPT code should I use for a flexible laryngoscopy in the office? asks Ken Stein, PA-C, with Hunter & Clark PC, specializing in otolaryngology and facial plastic surgery in Oklahoma City.

Do this: Look at the anatomy that the otolaryngologist examines. Pinpointing whether the exam involved the larynx or the nasopharynx will tell you which flexible laryngoscopy CPT code you should use.

Option 1: If the scope goes all the way down to the larynx and looking at the larynx is medically necessary, you should bill the flexible laryngosocpy using 31575 (Laryngoscopy, flexible fiberoptic; diagnostic), says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

Option 2: If, however, the otolaryngologist examines only the nasopharynx, you should report 92511 (Nasopharyngoscopy with endoscope [separate procedure]). Example: A physician may look at the nasopharynx to evaluate eustachian tube dysfunction or a mass in the nasopharynx. Bill Standalone E/M Using Modifier 25 You-ve decided on 31575 or 92511, but you don't want to leave any charges on the table. -Should I bill the flexible laryngoscopy separately from the general ENT exam?- Stein asks.

Action: You should bill both the diagnostic scope and an E/M service when two requirements are met. The exam:

1. does not include the elements of the findings of the scope

2. stands on its own.

Look for Separate HEM -How can I identify a standalone E/M service?- you ask. The chart notes must describe a history, examination and medical decision-making that is significant and separately identifiable from the scope, Cobuzzi says. To bill an E/M service in addition to a scope, the office visit or consultation must qualify for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Prowl for 2 E/M Circumstances CMS further limits the opportunities to report an E/M service in addition to 31575 and 92511. The National Correct Coding Initiative (NCCI) version 7.2 introductory language added a minor related E/M service to all procedures that contain XXX global days. That means the -laryngoscopy and nasopharyngoscopy both include a small E/M service,- Cobuzzi says.

Impact: An E/M service only qualifies for separate reporting from a diagnostic scope when the office visit or consultation [...]