Otolaryngology Coding Alert

Question: How should I code a postoperative visit? Should I charge for the visit? Do I need a modifier?

Florida Subscriber

Answer: You should first determine how the office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) relates to the operation. If the visit relates to the surgery, and the operation's global period is still effective, you shouldn't charge for the postoperative E/M service. To track the visit, you may enter 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure) at a zero-dollar value.
 
On the other hand, when your otolaryngologist performs an E/M service that doesn't relate to the surgery and a global period exists, you should charge for the treatment. Make sure the office visit's diagnosis is different from the operation's. To indicate that the service is unrelated to the surgery's global period, you should append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code.
 
Apply the above rules to the following scenario: One month after receiving a tympanoplasty (69631, Tympanoplasty without mastoidectomy [including canalplasty, atticotomy and/or middle ear surgery], initial or revision) (90 global days), a patient presents for an office visit to his operating otolaryngologist. If the office visit is for otitis media (e.g., 382.1, ... chronic tubotympanic suppurative otitis media), the E/M service relates to the surgery. In this case, you should report 99024 at $0. But suppose the patient comes in for laryngitis (464.00, Acute laryngitis; without mention of obstruction). Because the visit is unrelated to the operation, you should report the appropriate-level E/M service (99212-99215) appended with modifier -24 and linked to 464.00.