Otolaryngology Coding Alert

Make proper use of +69990, 92504 to avoid rejection. Your ENT has invested training time and money in her telescope or binocular microscope and it's no surprise she wants reimbursement when she uses it. But when can you separately code operating microscope use? Know the rules and the exceptions to get the dollars you deserve, and to stay out of the auditors- field of vision. Our experts break it down for you. Check for -With Microscope- Code First Numerous CPT codes provide for the use of an operating microscope or telescope. Frequently, separate codes describe similar surgeries performed with and without these tools. Surgical example: Say your ENT performs a direct laryngoscopy with dissection and removes a cyst. If she does not use a microscope, you-d code 31540 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis). If she does use and document the use of a microscope, you-d code 31541 (... with operating microscope or telescope). Use +69990, 92504 Only in the Right Circumstances In some cases, when there's no mention of a microscope in the code description for a service, you may be able to report +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) or 92504 (Binocular microscopy [separate diagnostic procedure]). Key: You should report +69990 or 92504 only if the value of the procedure (relative value units, or RVUs) does not incorporate the use of the microscope in the calculation. That means that depending on the procedures you perform, you may use these codes only rarely. "We never really bother with +69990 since it is considered to be an inclusive component," says Renee Johnson, office manager for Cape Fear Otolaryngology in Fayetteville, N.C. "I did bill +69990 a few times when I worked in plastic surgery." 92504 Is for Office Microscopy When your ENT uses a microscope to examine and diagnose a patient in an office or clinic, you may be able to report 92504. Keep in mind that CPT designates this as a separate procedure; that means payers include it in any other procedure done in the same anatomic area. You would only use 92504 if that is the only procedure your ENT performed and documented. E/M example: Let's say in the clinic your ENT removes tubes from a 13-year-old's eardrum without anesthesia. Because your ENT isn't using anesthesia on the child, you can't report 69424 (Ventilating tube removal requiring general anesthesia). But, if she uses the binocular microscope to help her see what she's doing, you could report 92504. If the physician also performs and documents a significantly and separately identifiable E/M at the same encounter as the 92504 -- for instance, [...]