Otolaryngology Coding Alert

Question: An otolaryngologist -seems- to be doing an endoscope on every patient at every encounter. When does the scope become a standard of practice or standard of care and thus uncodable? Should I code the scope only when the ENT documents that he could not visualize the anatomy with the mirror or makes some other qualifying statement?

Should I count the anatomy that the otolaryngologist views during a scope in the E/M examination?

Minnesota Subscriber

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Answer: First, you should never bill 31505 (Laryngoscopy, indirect; diagnostic [separate procedure]) unless it is the only service the otolaryngologist provides. When the physician performs an E/M service (such as 99201-99215, Office or other outpatient visit ,,,; or 99241-99245, Office consultation for a new or established patient) and a mirror exam, you should include 31505 in the E/M examination.

As far as your otolaryngologist frequently providing 31575 (Laryngoscopy, flexible fiberoptic; diagnostic), we really can't say whether that is the standard of care. Look instead at whether medical necessity supports performing the procedure. The physician should not do the scope just as an easy way to complete the larynx element of an E/M's exam.

If the ENT includes the element in the exam, he should not also bill the scope. Counting the anatomy in both the E/M exam and 31575 is double-dipping.

Exception: Under one circumstance, the otolaryngologist may count the anatomic area in the exam, such as larynx, hypopharynx, pharynx, etc. If the ENT indicates some finding or that he could not visualize manually on exam and then documents the finding in the scope procedure note, he can count the element in both places.