Otolaryngology Coding Alert

Question: An otolaryngologist removes tubes in the office using the operating microscope. Should I use 69210 or an E/M with 92504? Florida Subscriber Answer: There is no operating microscope in the office. An operating microscope is only found in the operating room. The equipment is large, unwieldy and often attached to the ceiling. You are probably referring to a binocular microscope. Ventilating tubes are not considered foreign bodies. "Removal of tympanostomy tubes in the office setting does not meet the criteria of a foreign body removal [FBR]," according to the American Academy of Otolaryngology -- Head and Neck Surgery. A surgeon placed them there for a purpose. A foreign body is an object that is not supposed to be there, such as a bead or corn puff. Therefore, you cannot use 69200 (Removal foreign body from external auditory canal; without general anesthesia) with 385.83 (Retained foreign body of middle ear). CPT contains a code for ventilating tube removal that requires general anesthesia (69424, Ventilating tube removal requiring general anesthesia) in the operating room. Because a modifier 52 appended code must not disturb the base service's identification, you should not add modifier 52 (Reduced services) to the code to indicate tube removal without anesthesia. Assuming you are referring to tube removal using a binocular microscope, your only alternative is to report the removal using an E/M code, such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient -). If the insurer adopted the Correct Coding Initiative's (CCI) version 7.3 verbiage that includes a minor related E/M with "XXX" global period procedures, such as 92504, you will need modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to indicate the documentation supports the E/M service as significant and separately identifiable from the minor service included in the microscopy (92504, Binocular microscopy [separate diagnostic procedure]). The E/M can be the decision to do the removal. For instance, the otolaryngologist might state he needed to use the microscope to help get the tubes out.