Otolaryngology Coding Alert

Question: I saw a patient for a Ludwigs angina without abscess formation (528.3). Due to his impending airway compromise, he required securing of his airway. He underwent an uneventful naso-tracheal intubation under a controlled setting in the operating room (OR). Although the intubation was performed by the anesthesia team, the patient was brought into the OR scheduled under my name, and I had to be there for tracheostomy standby should the controlled intubation not work. In a situation like this, can I code for the approximately three hours of ordeal I went through from initially seeing him in the intensive care unit (ICU) to bringing him down to the OR and then taking him back to the ICU with his airway controlled with the assistance of the anesthesia team? Further, I had to dictate the events that took place in the OR as it was scheduled under my name.

New York Subscriber

Answer: The otolaryngologist likely evaluated the patient in the intensive care unit and then opted for intubation. Therefore, he can bill for any evaluation and management (E/M) service performed in the ICU, says Barbara Cobuzzi, MBA, CPC, CPC-H, an independent coding and reimbursement specialist in Lakewood, N.J.

If he then monitored the patient, he can bill using direct (face-to-face) prolonged services codes (99356-99357, inpatient) as long as the time he spent is well documented because prolonged services E/M codes are time based (see article on prolonged services on page 19). Because some carriers are likely to question and/or deny these claims, Cobuzzi says the specific start and stop times should be listed in the documentation. Non-direct prolonged services codes and standby E/M codes rarely are paid, she adds.