Otolaryngology Coding Alert

4 scenarios show you when to claim surgery-related reimbursement

If you assume that all E/M services in which your otolaryngologist discusses a major operation with a patient are nonreportable, you'll miss ethically deserved payment.

Because CPT includes preoperative visits in a procedure's global surgical package, you may think that you shouldn't code any surgery-related visits. But you should separately report some encounters.

To make sure you don't omit any pre-op pay, test your skills with this quiz. Patient Requires Surgical Clearance Question 1: Which CPT code should you report for the following encounter?

A mother presents with her 5-year-old daughter, whom the otolaryngologist previously scheduled for a tonsillectomy and adenoidectomy (T&A) to the physician's office on the surgery date. The otolaryngologist examines the patient to make sure she is healthy enough to undergo surgery and that she still requires the operation. The mother and child then see the surgery scheduler, a registered nurse. The RN explains the operation and answers the mother's surgery questions. The guardian signs the surgery consent forms. The RN sends the patient to the hospital for physician-ordered blood work. Answer: None. You shouldn't report a code for the patient's visit. "CPT does not have an evaluation and management code for a preoperative visit," says Jessica Loyd, billing manager at ENT Center in Denver. You  should instead include the encounter in the surgical code.

Here's how: You should report 42820  (Tonsillectomy and adenoidectomy; under age 12) for the operation. The code includes the preoperative visit to check the patient's status prior to surgery and perform all necessary presurgical work.

You shouldn't separately report the office visit because it relates to the T&A. "CPT's surgical package includes one related E/M encounter, including history and physical, on the date immediately prior to or on the date of the procedure," says Karen Strickler, assistant manager/billing manager at Southeastern ENT & Sinus Center in Greensboro, N.C.

ENT Decides Patient Needs Surgery Be careful: Don't assume that CPT's surgical package includes all E/M services that your otolaryngologist performs 24 hours prior to surgery. Sometimes, a patient's encounter may lead to the decision for immediate surgery. In these cases, you should bill the service. Question 2: Three days after an otolaryngologist admitted a patient with parotitis to the hospital, the patient develops a parotid abscess that requires complicated draining. At that time, the otolaryngologist decides to drain the abscess. Should you report the E/M service? Answer: Yes, you should report the appropriate-level hospital visit (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient) appended with modifier -57 (Decision for surgery) in addition to the parotid drainage (42305, Drainage of abscess; parotid, complicated).

Reason: Because the otolaryngologist made the decision for surgery during that encounter, you should [...]