Otolaryngology Coding Alert

Question: I’m not sure when I can use 92504. I know I shouldn’t charge 92504 with G0268, but what is an example of appropriate 92504 reporting?

Kansas Subscriber

Answer: CPT designates binocular microscopy as a “separate procedure.” So you should report 92504 (Binocular microscopy [separate diagnostic procedure]) only when your otolaryngologist performs no other ear procedure during the same visit.

Therefore, you shouldn’t report 92504 with G0268 (Removal of impacted cerumen [one or both ears] by physician on the same date of service as audiologic function testing) or 69210 (Removal impacted cerumen [separate procedure], 1 or both ears). Because the otolaryngologist performs both procedures on the same anatomic area, it would be inappropriate to report 92504.

But when the otolaryngologist looks in the ear and doesn’t perform a procedure, you should code the look-see (92504). And if the otolaryngologist performs a significant, separately identifiable service from the binocular microscopy’s minor E/M, you should report the office visit (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established 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) in addition to 92504.

You should also submit 92504 when the otolaryngologist uses the binocular microscope and performs an unrelated procedure. Suppose after an E/M service, your physician looks in the patient’s ear and performs a nasal endoscopy. Because the look-see and scope occur on separate body areas, you should report both procedures.

Append modifier 59 (Distinct procedural service) to 92504 to indicate the microscopy as a distinct procedural service from 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]). Modifier 59 tells the payer that the 92504 is being performed at a different site than where the 31231 is being performed.  If the physician performs a significant, separately identifiable E/M service, also submit 99201-99215 with modifier 25.