Otolaryngology Coding Alert

Question: My otolaryngologist coded a surgical session as follows:

69540
69424 ventilating tube removal when originally inserted by another physician
92502

I know 69424 is incorrect because he personally placed the tubes last year. But would an unlisted procedure code be appropriate, given that the removal was performed under anesthesia? Or would the removal be included in 92502?

California Subscriber

Answer: Based on the information provided, 69540 (excision aural polyp) is the only code that should be billed for this operative session.

No code, listed or unlisted, should be billed when the same physician who placed the tubes removes them, says Randa Blackwell, an otolaryngology coding and reimbursement specialist with the department of otolaryngology at the University of Maryland in Baltimore.

However, Blackwell notes, 92502 (otolaryngologic examination under general anesthesia) can be separately payable if the patient was taken to the operating room (OR) to have the tubes removed under anesthesia. Tube removals are usually performed in the doctors office, she explains. If a patient requires a trip to the OR to have his or her tubes removed, its usually because the procedure will be too painful for the patient to sit still. Under those circumstances, the physician will always examine the patient after the tubes are removed, and 92502 may be billed.

Code 92502 probably should not be billed in this case, however, because it is bundled with 69540 in the national Correct Coding Initiative. Although 69540 may be performed with or without anesthesia, in this case anesthesia was delivered during the surgical session.

The edit includes a 1 indicator, meaning modifier -59 (distinct procedural service) will override it, but to be considered distinct the two services would have to be unrelated (for example, performed at different sessions on the same day), which is not the case in this scenario.