Otolaryngology Coding Alert

Otolaryngologists sometimes perform surgeries with other specialists. In such cases, coding depends on the answers to a number of questions, such as:
 
1. Did both surgeons perform a part of one procedure, or did each surgeon perform a separately payable service?
 
2. Was there a primary surgeon and an assistant, or did both surgeons have relatively equal roles?
 
3. Does the fee schedule allow the procedure to be billed with modifier -62 (two surgeons)?
 
 
The procedure described in the following article illustrates when modifier -62 may be correctly used to inform carriers that two surgeons (typically, but not necessarily, of different specialties or subspecialties) performed different aspects of the same procedure.
Otolaryngologists As Co-Surgeons  
Occasionally otolaryngologists are asked to take a biopsy, remove a tumor, or resect a portion of the pituitary gland. When a neurosurgeon schedules the procedure, the services of an otolaryngologist may be requested.
 
The procedure involves accessing the base of the sella turcica (latin for Turkish saddle, a depression across the midline on the superior surface of the body of the sphenoid bone that contains the hypophysis, so named because it resembles a saddle when viewed from the side).  

When the inferior aspect of the sella turcica is accessed through the nose, a small hole is drilled in the skull base, the pituitary gland is identified, and the tumor or malignant tissue is excised. In some cases, a neurosurgeon may ask an otolaryngologist to deal with the nasal approach to the sella turcica, says Sanford Archer, MD, an otolaryngologist and associate professor at the University of Kentucky's College of Medicine in Lexington.
 
"The otolaryngologist typically takes down the anterior wall of the sphenoid sinus and puts the speculum in place. After that, the neurosurgeon takes out the back and superior walls of the sphenoid sinus to get to the sella turcica. Once the pituitary tumor or biopsy is removed, the otolaryngologist closes up," Archer says.
 
The otolaryngologist may approach the sella turcica in several ways, he says, noting that the most common approaches are through the septum via the upper lip. Another approach that is coming into favor uses a nasal endoscopy.
 
Although the sella turcica is a part of the skull base, CPT does not consider the removal of pituitary neoplasms skull-base surgery, notes Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPT's editorial panel and executive committee.
 
"This procedure is reported using one code only, whether performed by one [...]