Otolaryngology Coding Alert

Question: Our otolaryngologist performed an evaluation and management (E/M) exam on a 24-year-old patient who arrived at the emergency room (ER) with a severe case of acute tonsillitis. The physician concluded that the patient needed an emergency tonsillectomy and proceeded to perform the tonsillectomy in the operating room (OR) the same evening. How should this be reported?

Colorado Subscriber

Answer: An on-call otolaryngologist treating a patient in the ER may bill for the corresponding E/M code under the appropriate circumstances. In this example, you’ve got to take a number of variables into consideration including CPT^® codes, modifiers, and place of service (POS) codes.

To begin, you’ll need to select the correct level of service within the E/M code range 99281-99285 (New or Established Patient Emergency Department Services). Next, you’ll append a modifier to the E/M code indicating that the physician made a decision to perform surgery on the same date of service (DOS). This means appending modifier 57 (Decision for Surgery) to the E/M code. Finally, you’ll report CPT^® code 42846 (Tonsillectomy, primary or secondary; age 12 or over).

Your last coding consideration has to do with allocating the respective place of service (POS) codes to the E/M and surgical services. For the ER evaluation, you’ll append POS code 23 (Emergency Room – Hospital). Assuming the patient remains an outpatient, you’ll append POS code 22 (On Campus- Outpatient Hospital) to code 42826.