Otolaryngology Coding Alert

Answer: The Correct Coding Initiative version 7.3, October 2001, changed its global period verbiage to read that procedures with xxx days include a minor E/M attached to them, just like 0- to 10-day procedures, says Barbara Cobuzzi, MBA, CPC, CPC-H, president of Cash Flow Solutions, Lakewood, N.J. Therefore, the otorhinolaryn-gologic services encompass a small E/M service.

If there is a separate, identifiable reason for a separate E/M, you may bill the E/M with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). In the tubes scenario in "Come to Equal Terms When Billing for Postop Tube Removal," on page 58, the doctor uses the microscope to inspect a patient's tubes and the tympanic membrane as part of the patient's postoperative care. The microscopy includes the minor E/M, so you can bill either the microscopy (92504, Binocular microscopy [separate diagnostic procedure]) or the office visit (99211-99215, Established patient office visit). No significant, separate E/M occurred to warrant reporting both services.

For instance, suppose the patient has a change in status, such as a fever, and the doctor examines her for the illness and performs and documents a history, exam and medical decision-making, and checks her tubes with the microscope. You can then report the appropriate-level office visit, linked to the diagnosis for fever (780.6) with modifier -25, and the microscopy linked to otitis media (382.9). Although separate diagnoses are not required, they help substantiate that a separate, identifiable service was provided.