Otolaryngology Coding Alert

Question: When my physician performs both laryngoscopy and bronchoscopy at the same time with the same scope, how should I report this, and can I bill out for both with a 59 modifier?

Ohio Subscriber

Answer: When your physician does both laryngoscopy and bronchoscopy with the same scope during the same session, you should only bill for the bronchoscopy, as it is the most comprehensive code. The separate procedure designation in the descriptor for bronchoscopy would not apply in this situation since bronchoscopy is not being done as part of a larger procedure. However, all this may depend on the insurance carrier.

Here’s why: The CPT^® “separate procedure” definition states that if a CPT^® code descriptor includes the term “separate procedure,” this indicates that the procedure can be performed separately but should not be separately reported when a related service, such as one in an anatomically related region, is performed.

However, you may report a CPT^® code with the “separate procedure” designation with another procedure if it is performed at a separate patient encounter on the same date of service or at the same patient encounter in an anatomically unrelated area, often through a separate skin incision, orifice, or surgical approach. In such cases, you should append modifier 59 (Distinct procedural service) or a more specific X{EPSU} modifier (for those payers that except them) to the “separate procedure” CPT^® code to indicate that it qualifies as a separately reportable service.

When two different scopes are used, reporting may change. The Medicaid National Correct Coding Initiative (NCCI) policy manual states, “If medically reasonable and necessary endoscopic procedures are performed on 2 regions of the respiratory system with different types of endoscopes, both procedures may be separately reportable. ... It must be medically reasonable and necessary to use 2 separate endoscopes to report both codes.”

So, if it was medically necessary to use both a laryngoscope and a bronchoscope because of some anatomic limiting factor and this is documented, as well as the use of the two different endoscopes, then modifier XU (Unusual non-overlapping service …) (or modifier 59 if the payer doesn’t recognize X{EPSU} modifiers) could be applied to the laryngoscopy CPT^® code.