Otolaryngology Coding Alert

Question: The otolaryngologist was called to the emergency room to examine a patient, who then was transferred to the operating room, A laryngoscopy was performed along with a trach change. The otolaryngologist then consulted with the primary care physician. The trach tube had to be changed again twice before the patient was stable enough to leave. How do I code this?

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Answer: If the otolaryngologist was called to see the patient and as a result of that evaluation determined that the laryngoscopy and trach tube change had to be performed, a consult may be charged if all the criteria for billing it are met, says Teresa Thompson, CPC, an otolaryngology coding and reimbursement specialist in Sequim, Wa. The criteria are stated in the Medicare Carriers Manual, section 15506:
 
1. A consultation is distinguished from a visit because it is provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician
 
2. A request for a consultation from the other physician and the need for consultation must be documented in the patient's medical record
 
3. After the consultation, the consulting surgeon prepares a written report of findings that is provided to the other physician.
 
 
Note: In the hospital setting, a separate report is not required. The report can be an entry in the patient's common medical records (i.e., progress notes, recommendations for treatment, etc.).
 
Without more specific information about the patient's problems or the type of laryngoscopy performed, specific procedure codes cannot be recommended. If (as is usually the case) the trach tube changes did not require the establishment of a new fistula tract, the changes are not separately payable, and only the laryngoscopy should be billed. Because, in this situation, the otolaryngologist had to spend significant additional time performing three trach tube changes, it may be appropriate, depending on the otolaryngologist's documentation, to append modifier -22 (unusual procedural service) to the correct laryngoscopy code.