Otolaryngology Coding Alert

Question: May I use 'rule out' (R/O) as the reporting diagnosis?


Ohio Subscriber

Answer: You should not code a disease or condition unless the otolaryngologist makes a definitive diagnosis. If the physician performs tests to rule out a diagnosis and the diagnosis is not established when you submit the claim, you should only code the chief complaint, or signs and symptoms related to the 'rule out' or 'possible' diagnosis.

Suppose: A new patient presents with chronic laryngitis and based on the history and examination the otolaryngologist decides to perform a flexible laryngoscopy to rule out a laryngeal neoplasm.

The scope shows no abnormalities.

You would report the office visit (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient ...; 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) and the flexible laryngoscopy (31575, Laryngoscopy, flexible fiberoptic; diagnostic). Link both the E/M and the procedure to the chief complaint - chronic laryngitis (476.0), not to the rule out diagnosis - neoplasm (such as 212.1, Benign neoplasm of larynx).