Otolaryngology Coding Alert

Question: My otolaryngologist frequently keeps thyroidectomy patients in the hospital for an extra day to monitor their recovery. Which code should I use for the subsequent day's E/M service?

Maryland Subscriber Answer: Due to the thyroidectomy's global period, you shouldn't report the extra day unless the patient has a problem. For instance, if the patient has hyperglycemic shock (250.8x, Diabetes with other specified manifestations), you should report subsequent hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...). To indicate that the E/M service is unrelated to the thyroidectomy (such as 60240, Thyroidectomy, total or complete), make sure to append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to 99231-99233. 

For normal recovering patients, you shouldn't report the extra hospital "monitoring" day. CPT considers the monitoring part of postoperative follow-up care and includes the service in its surgical package. In addition, payers that use global days will bundle 99231-99233 into the thyroidectomy's (60240-60271) 45- or 90-day global period.