Otolaryngology Coding Alert

Question: How should I code for an exam of the ears under anesthesia, removal of tympanostomy tubes and debridement of granulation polyp? The same physician placed the tubes two years ago, and all three procedures were performed during the same operative session.

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Answer: If the granulation polyp is inside the ear (in this case, the most likely scenario), only the debridement of the granulation polyp can be billed. Without an operative report, the exact code for this procedure cant be ascertained, but 69540 (excision aural polyp) may apply.

The tube removal cannot be billed because the same physician performed the insertion less than three years ago. The examination of the ears under anesthesia is a separate procedure and can be billed only if it is the only procedure performed, says Chrissy Rogan, CPC, a coder in a two-otolaryngologist practice in Alexandria, Va.

If, however, the polyp is inside the nose, the examination (92502, otolaryngologic examination under general anesthesia) would be billable. Modifier -59 (distinct procedural service) would need to be attached to 92502 to indicate it was performed on a separate site from the polyp debridement, Rogan says.