Otolaryngology Coding Alert

Question: When an otolaryngologist performs a same-day office visit and mirror exam, should I include the diagnostic procedure in the E/M code? May I bill 31505 if the physician uses the mirror to diagnose a separate problem?

Virginia Subscriber

Answer: You should never bill 31505 (Laryngoscopy, indirect; diagnostic [separate procedure]) in addition to 99201-99215 (Office or other outpatient visit for the evaluation and management of a new or established patient ...). The laryngeal mirror, or indirect laryngoscopy, is considered an integral part of an otolaryngologic examination. The findings from the mirror exam is what is counted toward the examination of the larynx as part of the ENT exam. Thus, the E/M service does not qualify as significant and separate from the procedure or warrant modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

Code 31505's designation as a "separate procedure" means you should report a mirror exam only when the otolaryngologist performs no other service in that anatomical area. "Separate procedures are services that are commonly carried out as an integral part of a larger service, and as such do not warrant separate identification," states CPT's "Separate Procedures" notes. Therefore, you should bill 31505 only if it is the sole service the otolaryngologist provides to the patient during the visit.

Better method: Because the mirror exam is a component of and incidental to the E/M service, the otolaryngologist should roll the mirror exam into the E/M examination. The diagnostic procedure may boost the examination portion by increasing the number of systems (1995 guidelines) or bullets (1997 guidelines).