Otolaryngology Coding Alert

Another Correct Coding Initiative (CCI) 6.2 change has otolaryngological examinations performed under general anesthesia (92502, otolaryngologic examination under general anesthesia) bundled into most otolaryngology procedures.

Although it is a significant change affecting otolaryngologists, the edit of 92502 to most otolaryngological procedures actually changes very little, as otolaryngologists infrequently use this code, in part because its a component status of procedures that already involve general anesthesia.

For example, according to version 6.2, 92502 now is a component of a sphenoidotomy with removal of tissue. As this procedure is performed on a patient already under general anesthesia, it would have been difficult to imagine a scenario in which the otolaryngologist could bill separately for any exam performed while the patient was anesthetized.

Usually, 92502 is billed when the otolaryngologist needs to anesthetize a patient (typically, a child) to perform an exam. It also might be used if the otolaryngologist is removing tubes from the ear of a child who also has had a relatively recent adenoidectomy and decides to reevaluate the childs nasal pharynx. In that case, the physician could bill separately for the examination under anesthesia, making sure that the diagnosis code linked to 92502 relates to the nasal pharynx, not the tube removal.

Note: If the otolaryngologist also inserted the tubes, he or she cannot bill for their removal. If a paper patch is performed, code 69610 (tympanic membrane repair, with or without site preparation or perforation for closure, with or without patch) could be billed along with the 92502. Because 92502 is bundled to 69610, modifier -59 (distinct procedural service) should be attached to 92502 to indicate the exam was for the nasal pharynx, not for the paper patch.