Otolaryngology Coding Alert

Question: I know I shouldn't charge G0268 in addition to 92504. But would you give some examples of when my otolaryngologist should bill binocular microscopy with an ear or nose procedure?

North Carolina Subscriber Answer: CPT designates 92504 (Binocular microscopy [separate diagnostic procedure]) as a "separate procedure." Therefore, you should report binocular microscopy only when the otolaryngologist performs no other procedure on the same body area during the visit.
 
You'll typically charge 92504 when the exam doesn't result in or relate to the encounter's procedure.
 
Example 1: An otolaryngologist looks into a patient's ear with the binocular microscope but doesn't perform a procedure.
 
In this case, you should report the microscopy (92504) and the E/M service (99201-99215, Office or other outpatient visit for a new or established patient ...) appended with modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). The modifier indicates that the service is significant and separately identifiable from the minor E/M the National Correct Coding Initiative (NCCI) includes in 92504.
 
Example 2: Based on an E/M's history, examination and medical decision-making, an otolaryngologist looks in a patient's ear and performs a nasal endoscopy.  
 
Because the physician performs the exam on a different body area from the procedure, you should report both the binocular microscopy (92504-59, Distinct procedural service) and the scope (31231, Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]). To indicate that the procedures occur on separate sites, append modifier -59 to 92504.
 
Watch out: When your otolaryngologists uses 92504 as a "look see" prior to performing a procedure, you shouldn't separately report the microscopy.
 
For instance, to view a child's nasal cavity, an otolaryngologist uses binocular microscopy, which reveals a bead lodged in the patient's nose. The otolaryngologist removes the bead. Because the otolaryngologist performs the procedures in the same body area - the nose - you should bill only the bead removal (30300, Removal foreign body, intranasal; office type procedure), not the microscopy.
 
This same reason also explains why you shouldn't bill G0268 (Removal of impacted cerumen [one or both ears] by physician on same date of service as audiologic function testing) when the otolaryngologist looks in the patient's ear prior to removing impacted cerumen (69210, (Removal impacted cerumen [separate procedure], one or both ears). The procedures occur on the same site.