Otolaryngology Coding Alert

Question: An otolaryngologist sees a patient for an initial consultation in which he reviews sleep study results, obtains a patient history and performs an examination. The physician performs a flexible fiberoptic laryngoscopy along with a Mueller test, in which he evaluates the patient's nose, palate, oropharynx and hypopharynx, looking for signs of blockage that may be causing sleep apnea.

Should I charge a detailed new patient office examination (99203) as well as the fiberoptic laryngoscopy (31575)? Why or why not?

Also, should I code the Mueller test? If so, which  procedure code should I use? For instance, would I have to report an unlisted-procedure code, such as 31599?

Oregon Subscriber

Answer: Although you should definitely submit the fiberoptic laryngoscopy with 31575 (Laryngoscopy, flexible fiberoptic; diagnostic), reporting the E/M service (99203-25, Office or other outpatient visit for the evaluation and management of a new patient ...; Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and the Mueller test (92700, Unlisted otorhinolaryngological service or procedure) depends on your otolaryngologist and his documentation.

To code the new patient visit, your otolaryngologist must perform and document a significant, separate E/M from the minor history, examination and medical decision-making the laryngoscopy includes. Think of a separate visit as one in which the physician provides more evaluation and management services than a prescheduled laryngoscopy requires.

Because your scenario involves a new patient, you  should probably report 99203-25 in addition to 31575, if the physician's documentation supports the separate E/M. A new patient office visit (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient ...) usually requires the otolaryngologist to perform more significant evaluation and management services than an established patient visit (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) necessitates. To indicate that the office visit is a significant, separate service from the laryngoscopy, append modifier -25 to 99203.

Tip: If your otolaryngologist separates the procedure from the E/M in the documentation, you will have an easier time showing a payer that you deserve office visit payment. The insurance reviewer can see that the E/M is separate from and led to the decision to perform the laryngoscopy. The physician should also note why the scope is medically necessary, such as macroglossia or "due to gag reflex."

Experts don't recommend separately reporting the Mueller test. Many otolaryngologists consider the test part of the oropharynx exam that the EM includes. If your physician insists on billing the test, you could submit 92700 with a description of the Mueller test. You would have to use an unlisted-procedure code because no specific CPT code describes the service.

If you choose to report the Mueller test, you should categorize the service with 92700 instead of 31599 (Unlisted procedure, larynx). A Mueller test is not a larynx procedure as 31599 describes, but a nose, palate, oropharynx and hypopharynx exam. Therefore, the test falls under an unlisted otorhinolaryngological service, rather than a larynx procedure.

If you decide to use 92700, you may need to downcode the E/M level. Make sure you don't count the Mueller test's history, exam and medical decision-making in the office visit code. That may mean you don't have enough components to support 99203-25.