Otolaryngology Coding Alert

Question: A vacationing, out-of-state, non-Medicare post-tonsillectomy patient presents to my otolaryngologist's office for severe bleeding. The otolaryngologist discovers that the bleeding is coming from the right fossae and controls the bleeding with simple cautery. What modifier should I use for my otolaryngologist's services?

Florida Subscriber
 
Answer: You should report the cautery (42960, Control oropharyngeal hemorrhage, primary or secondary [e.g., post-tonsillectomy]; simple) without a modifier. Because your otolaryngologist didn't perform the tonsillectomy (such as 42825, Tonsillectomy, primary or secondary; under age 12), no surgical package exists and no modifier is necessary.
 
Only the otolaryngologist who performed the tonsillectomy (such as 42825, Tonsillectomy, primary or secondary; under age 12) would need to use modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to break the 90-day global period of 42825-42826. Because, in this case, the cautery would be related to the tonsillectomy that the surgeon performed, the surgical package includes the postoperative care.