Otolaryngology Coding Alert

Question: If we remove tubes inserted by another physician in the office, how should we code this? Code 69424 is with general anesthesia only. Our compliance office told us to use an unlisted-procedure code (69799, Unlisted procedure, middle ear). Is this correct? Why couldn't we use modifier -52 (Reduced services) with 69424?

Answer: Previously, only a physician who did not place the ventilating tubes could report 69424, Ventilating tube removal when originally inserted by another physician (2002 definition). For 2003, 69424 (Ventilating tube removal requiring general anesthesia) requires general anesthesia but no longer specifies that the physician who bills for removal be a different doctor than the doctor who inserted the tubes.

Prior to the revision, otolaryngologists could only receive payment for tube removal when they did not place the tubes (69436, Tympanostomy [requiring insertion of ventilating tube], general anesthesia). If the same physician placed and removed tubes under general anesthesia, he or she could bill for the placement only. Code 69436 included the fee for both procedures. The AMArevised 69424 because otolaryngologists complained that reimbursement for 69436 did not adequately cover the removal.

Therefore, CPT 2003 intends for the revised 69424 to pay otolaryn-gologists for the removal under general anesthesia. It is not intended to cover payment for in-office tube placement, which physicians can usually perform in seconds during an office visit. Instead, you should include the work performed in the tube removal in the E/M (99212-99215, Office visit for an established patient ...), provided documentation supports the appropriate-level E/M.

"If the doctor documents a good enough history and exam, the medical decision-making could potentially help raise the E/M code a level," says 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. If the otolaryngologist just writes, "Here to have tubes removed" and removes them, not much of a history or examination exists to support billing an office visit. To bill an E/M, you need a history or exam in addition to medical decision-making to support the E/M, she says.

Answers to Reader Questions and You Be the Coder provided by 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; and Laura Siniscalchi, RHIA, CCS, CCS-P, CPC, senior consultant for Deloitte & Touche in Boston.