Otolaryngology Coding Alert

Question: Our physician admitted a patient to the hospital for dehydration, dysphagia, and acute tonsillitis.

The next day, she performs a tonsillectomy then discharges the patient. I coded 99222 for the admission in addition to the tonsillectomy procedure. But the insurer says the admission the day before is included in the surgery. Is this right?

Oregon Subscriber

Answer: You should append modifier 57 (Decision for surgery) to 99222 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. &) and resubmit your claim.

Ordinarily, the global surgical period for major surgeries under the Medicare fee schedule begins one day prior to the procedure itself and includes one preprocedure E/M service for patient evaluation.

But you should not include your ENTs initial evaluation of the problem to determine the need for surgery as a part of the surgical package. In such cases, you must append modifier 57 to the appropriate E/M service code.