Otolaryngology Coding Alert

Question:An ENT sees a patient in follow-up for a tympanoplasty (69436, Tympanostomy [requiring insertion of ventilating tube], general anesthesia), within the insurer's 10-day global period for the minor procedure. The physician performs the follow-up, and the mother complains the child is sneezing and has had a clear runny nose. The note indicates, "Chief complaint: Patient presents for tube check and complains of clear rhinitis.Exam: Ears clear, no fluid. Nasal membranes swollen and red.Assessment/Plan: This patient has chronic OM that has resolved. She is given a free sample of Astelin for the rhinitis. Follow up here as needed."Should I charge an E/M service for the new problem?Washington SubscriberAnswer:Yes, the global package includes only postoperative care related to the original surgery. For an E/M service that is unrelated to the surgery, you should report the appropriate level of care appended with modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period).Link 99212-24 (Office [...]