Otolaryngology Coding Alert

Question: My otolaryngologist is asked by the patient's internist to see a patient who has parotiditis. The otolaryngologist decides the abscess requires same-day surgical drainage. Should I report the procedure and a consultation?

Otolaryngology Coding Alert Subscriber

Answer: The consultation led to the decision to perform surgery, therefore you should report the surgical procedure and the consultation. For the drainage of the parotid, bill 42305 (Drainage of abscess; parotid, complicated). To indicate that the otolaryngologist provided a separate service from the consultation, append the appropriate initial inpatient consultation code (99251-99255) with modifier -57 (Decision for surgery).

If the doctor performed a simple drainage, report 42300* (... parotid, simple), which has a global period of 10 days (minor procedure), and the consultation appended with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Modifier -57 is reserved for use with evaluation and management services performed with major procedures only.

Make sure documentation shows that the internist requested your otolaryngologist's opinion.

--Clinical and coding information for You Be the Coder and Reader Questions reviewed by Barbara Cobuzzi, MBA, CPC, CPC-H, president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J; and Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J.