Otolaryngology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: The otolaryngologist performs a tonsillectomy (42826) and inserts tubes (69436). Are these procedures, which are performed at entirely different sites, subject to multiple-procedure reductions? New York Subscriber   Answer: They should not be, but many carriers apply them. The original rationale for reducing the fees for multiple procedures i.e., if two procedures are performed using the same incision, the opening and closing already is included in one of the procedures and should not be reported twice does not apply here because the services are at different sites (ears and throat). A secondary reason (that still applies) is that the pre- and postoperative periods are factored into 42826 and 69436, even though in this case there will be only one preoperative period. Whether as an attempt to recoup the pre- and postoperative duplication or simply as a budgetary tool, many payers routinely pay reduced fees for any multiple procedures. In the case of tube insertion and tonsillectomy, otolaryngologists who still append modifier -51 (Multiple procedures) to codes should not do so here because this supports the payer's case that the procedures are linked, when in fact they are not. Note: Many Medicare and other carriers no longer require modifier -51 to be appended. Some instruct their physicians specifically not to use modifier -51.