Otolaryngology Coding Alert

Choosing the correct code can make a difference of $50

When you-re attempting to distinguish nasopharyngoscopy from laryngoscopy, just remember this: What matters most is the area the ENT examines, not where he inserts the scope.
 
Site Examined Determines Proper Code

When choosing between nasopharyngoscopy (92511, Nasopharyngoscopy with endoscope [separate procedure]) and laryngoscopy (31575, Laryngoscopy, flexible fiberoptic; diagnostic), you should consider not whether the ENT introduces the scope through the mouth or the nose, as you might think. Instead, the key to proper coding is the anatomic area (nasopharynx or larynx) the ENT examines with the scope.

How mistakes happen: Sometimes physicians choose to perform a nasal scope insertion for a laryngoscopy because inserting the scope through the patient's nose is easier than making the patient hold his mouth open for a long time, and because going through the noise doesn't provoke the patient's gag reflex, says Tom Colletti, MPAS, PA-C, with Duke Medical Center in Durham, N.C. So if you read -nasal scope insertion- in your physician's documentation and assume he performed a nasopharyngoscopy, you could be jumping to an incorrect conclusion.

Money matters: Remember that 92511 reimburses higher than 31575 in the nonfacility setting (3.32 relative value units vs. 1.91 RVUs, or about a $50 difference, on average), so choosing the correct code has significant meaning for your bottom line, says Mary Tait, CPC, with Amerimed Billing and Consulting in Pocatello, Idaho.

Solution: Read your ENT's documentation very thoroughly to discern what anatomic part he examined with the scope procedure--this fact should guide your code selection.

For example, if the documentation states the physician performed a nasal scope insertion and examined the interior of the patient's larynx (this provides a better view of the upper airway than a traditional mirror exam), you would report 31575.

If, however, the physician examines the nasopharynx (that is, the eustachian tubes, adenoids and choanae, or the area where the pharynx and the nasal passages meet at the end of the hard palate), the correct code is 92511, regardless of where the ENT introduces the scope.

Call on 25 for Same-Day Scope and E/M

After you determine the correct scope code to report, you need to know whether you can bill for a same-day E/M services if your ENT performs one. You can't always bill for an E/M on the same day as 92511 or 31575, Tait says. To code for both services, you must have documentation that supports the medical necessity and the separate and distinct nature of the two services.

You must also append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code you report.

Learn more: For complete information on how to apply modifier 25 properly, see -3 Tips Minimize Modifier 25 Mishaps- in the February 2006 Otolaryngology Coding Alert.

Example: Otolaryngologists often make a same-day decision to perform a laryngoscopy. A patient may present for a completely separate problem (or for the same problem if the scope was not previously scheduled and the results of the E/M lead to the scope), and after the ENT provides the E/M service he may decide that a laryngoscopy is needed.

In this case, you can bill for both the E/M (with modifier 25) and 31575 as long as the physician's documentation clearly explains the distinct reason for the laryngoscopy. And, the physician should provide a separate procedure note for the laryngoscopy so you have documentation that both services are separate and distinct.

Don't do this: You cannot bill for both the E/M and 31575 if the patient comes in specifically for a laryngoscopy and the physician only takes the patient's vital stats but doesn't perform a full and separate E/M.