Otolaryngology Coding Alert

Question: A patient who had tympanostomy tubes presents within the global period with bilateral otitis media. Should I bill the visit using modifier -24, or is the service part of the global period?

North Carolina Subscriber

Answer: If the patient also has an upper respiratory infection, you have a good argument for separately charging for the visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...). The URI would indicate a new manifestation, rather than a surgical complication.
 
Append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to indicate that the E/M service is unrelated to the surgery (Tympanostomy [requiring insertion of ventilating tube], general anesthesia). Link 9921x-24 to the URI (465.9) in the primary position and otitis media (381.0x-382.9) in the second.
 
Although you could separately bill a visit for otitis media only, the payer would probably deny the service. The postoperative visit would contain the same diagnosis as the surgery. Therefore, the insurer would probably view the ear infection as a surgical complication, rather than a new manifestation, and deny payment.

- Answers to You Be the Coder and Reader Questions provided by Andrew Borden, CCS-P, CPC, CMA, reimbursement manager in the department of otolaryngology and communication sciences at Medical College of Wisconsin in Milwaukee; Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.; Asia Evans, coding specialist at Head and Neck Surgery Associates in Indianapolis; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.