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 Subscriber Answer: 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 visit for the evaluation and management of an established patient -) to the new problem diagnosis -- rhinitis (477.9). Do not include any E/M elements related to the postoperative care in the office visit level coded. If the physician had seen the patient for only a tube check, you would have instead used 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason[s] related to the original procedure]) with the reason-for-surgery diagnosis, such as otitis media (381.00-382.9).