Otolaryngology Coding Alert
Avoid 92504 When Procedure Leads to Increased Services
Question: If we have an established patient present with right ear pain in addition to concerns of a foreign body and the physician performs a binocular microscopy, can I bill out 99213 with 92504? Oklahoma Subscriber Answer: You’ll find the answer to this question in the code description for 92504 (Binocular microscopy (separate diagnostic procedure)). When a service is designated as a “separate diagnostic procedure,” you may always bill the service in addition to the evaluation and management (E/M) service it’s performed alongside. However, you want to be careful to only report code 92504 when the ear examination does not lead to any further service. For example, if the binocular microscopy reveals a foreign body, you should only report code 69200 (Removal foreign body from external auditory canal; without general anesthesia) if the provider opts to remove the foreign body at the same encounter. The same concept applies if the examination reveals impacted cerumen. In this case, you should only report code 69210 (Removal impacted cerumen requiring instrumentation, unilateral). One additional scenario might be if the binocular microscopy reveals nonimpacted cerumen, which the provider subsequently removes. In this case, you will include the cerumen removal as a component of the E/M service and submit 92504 separately. In the examples of 69200 and 69210, however, you will not report a separate E/M code in addition to the underlying service unless a significant and separately identifiable E/M was documented. Only if the binocular microscopy does not lead to any additional services should you report both 99213 and 92504.
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