Otolaryngology Coding Alert

Question: A patient who has tubes develops ear drainage six weeks postoperative. Although the tympanostomy's 10-day global period has expired, the patient is under a 90-day global period for a tonsillectomy. How should I report the sick visit?

Iowa Subscriber

Answer: You should report the appropriate E/M established patient office visit code (99211-99215). Link diagnosis code 382.00 (Acute suppurative otitis media without spontaneous rupture of ear drum) to the office visit code.

You should append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code. It may seem obvious that the office visit is for the otitis media, and therefore the modifier is unnecessary. However, the carrier's computer system may automatically reject the claim because it is during a postoperative period. The office visit is for an unrelated service (ear drainage) during a postoperative period of another surgery (the tonsillectomy, 42825, Tonsillectomy, primary or secondary; under age 12; 42826 age 12 or over).

When the second global period expires, report the E/M visit as you normally would without a modifier. This illustrates the importance of tracking global periods to make sure you are not losing reimbursement that you are entitled to.

Clinical and coding information for You Be the Coder and Reader Questions provided by Hayes H. Wanamaker, MD, chief, otolaryngology, Crouse Hospital, Syracuse, N.Y.; and Beth Thomsen, CPC, Associated Physicians of MCO Inc., Toledo, Ohio.