Otolaryngology Coding Alert

Question: My ENT performed a tonsillectomy and two days later the patient was admitted to the hospital due to dehydration. The doctor has indicated this is a result of the surgery. Can I bill for this?

Washington Subscriber

Answer: The answer depends on whether this is a Medicare beneficiary (or if the payer follows Medicare post-op complication rules). If so, you may not bill for the service resulting from the post-op complication unless the service involves a return to the operating room. The AMA, however, states in the beginning of the CPT manual's surgery section that complications are separately reportable.

Thus, append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the appropriate level E/M code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...) with a diagnosis of dehydration (276.51).