Otolaryngology Coding Alert

Question: The ENT meets with a patient and recommends a nasopharyngoscopy, which the patient schedules for the following week. We report a consult for this visit. On the day of the scope, the ENT re-examines the patient, answers questions, etc. The time spent prior to starting the procedure is 10 minutes. Should we bill this service as 99212-25 on the same day as procedure 92511?


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Answer: In this case, you won't report a separate E/M (even a low-level visit such as 99212, Office or other outpatient visit for the evaluation and management of an established patient ...) with the nasopharyngoscopy (92511, Nasopharyngoscopy with endoscope [separate procedure]).

Remember: All procedures include an -inherent- E/M component, according to CPT and CMS guidelines. To qualify as a separately billable service, any E/M the physician provides must be both significant and separately identifiable from the E/M component already included in the primary procedure.

If the ENT had provided the initial E/M service and the scope on the same day, you could report the E/M service separately using modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). In this case, however, the ENT has already conducted a full E/M workup prior to the nasopharyngoscopy, and you have already coded for this service.

At the time of the nasopharyngoscopy, if the patient has no new complaint or substantial change in her condition that prompts a new history, exam and medical decision-making process, you should not report a second E/M service. Report the nasopharyngoscopy only for this visit.