Otolaryngology Coding Alert

Question:

Colorado Subscriber

Answer:

No. You cannot bill 92504 (Binocular microscopy [separate diagnostic procedure]) for the binocular microscope with 69801 (Labyrinthotomy, with perfusion of vestibuloactive drug[s]; transcanal). Don't forget that 92504 is a separate procedure, meaning it is intrinsically included in anything else done in the ear. Separate procedures are components of anything else done in that area of the body and cannot be separately billed or coded. You can bill separate procedure when they are the only procedure done.

Example 1: Your otolaryngologist suspects a foreign body in a patient's ear. She looks in the ear, but doesn't find a FB. Because the physician didn't find and remove any objects, you should bill the look-see service with the binocular microscope (92504). If he had removed a foreign body from the external auditory canal, you would instead code the FB removal (69200, Removal foreign body from external auditory canal; without general anesthesia).

Sometimes, the physician uses binocular microscope and performs an unrelated procedure in a different body area, for example, a nasal scope, as well. In this case, you can report 92504

Example 2: An ENT looks in a patient's ear and also performs a nasal endoscopy. Because the look-see and scope occur on separate body areas, you should report CPTs that describe two separate procedures: 92504 for the microscopy, and 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) for the nasal endoscopy. You should append modifier 59 (Distinct procedural service) to 92504 to indicate it as a distinct procedural service from 31231. For example, a person can be complaining of negative ear pressure and nasal congestion. A binocular microscope is used to evaluate the tympanum membrane more carefully while the nasal endoscope is used to evaluate the sinuses. Separate diagnoses would be linked to each procedure, the eustashian tube dysfunction (381.81) to 92504 and nasal obstruction (478.19)