Otolaryngology Coding Alert

Question: The physician saw a patient, who had chicken bone stuck in his throat in the ER and did 31575, 92511. Later, the doctor brought him to the OR to perform 31530 and 43200.

South Dakota Subscriber

Answer: Assuming the documentation supports a significantly separately identifiable E/M service from the procedures, you should bill the case this way:

• 99284-25 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity) appended by modifier 25 (Significant and Separately Identifiable E/M on the same day as a procedure) to indicate that the physician performed and documented an E/M service that was separate from the minor procedures done on the same day.
• 92511-59 (Nasopharyngoscopy with endoscope [separate procedure]) appended by modifier 59 (Distinct procedural service) for nasopharyngoscopy in the ER for separate encounter
• 31530 (Laryngoscopy, direct, operative, with foreign body removal) to describe operative laryngoscopy
• 43200 (Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for esophagoscopy in the OR.

The ER procedures need modifier 59 to indicate they were done at a separate session from the two procedures performed in the operating room. You should appeal the refund requests on this premise, and explain the two encounters -- ER and OR and send in the notes.