Wiki Coding with 92502 and 92504

[ashlee59]

My question is:

Must the doctor always examine the ears, nose and throat when using the code 92502. Which is otolarygologic exam under general anesthesia?

My thought is yes.

Also, the code description does not mention use of any microscope, so either way it has to be exam of all 3, I am thinking.

Any thoughts out there?

Also, I've seen in an Op Report the use of binocular microscope for inspection of the ear and then 92502 is billed when I think it should have been 92504??

Help a sister out here. Thanks

I

 

[ashlee59]

92502 and 92504

One more thing.

I guess because 92504 doesn't mention with anesthesia maybe the use of 92502 is ok, but it still wouldn't be a complete exam if only the ears or ear is examined.

Thoughts??

 

[thanson123]

92502 vs 92504

Hi Ashlie: We met at the AAPC meeting this morning. I tried to help/psych coder. I have an old cpt, and yours reads the same. We've been taught that when you do a diagnostic service/exam and then remove something we are to code the removal code. Such as if you did a diagnostic arthroscopy and then removed something or trimmed a meniscus, etc., then it becomes a surgical procedure and you code for the surgery as the diagnostic is covered in the surgical code. The 92502 and 92504 do not speak of removing anything. Also, the old guidelines state that "Special otorhinolaryngologic services are those diagnostic and treatment services not included in an E&M service. These services are reported separatedly using 92502-92570." So I don't think you would be able to code an E&M service with these codes unless the 2013 has guidelines somethere that state you can. Does your doctor do E&M services and then decides to do the procedure at that time in the office (you stated that he can do these in the office), or is it set up where he provides an evaluation and then later schedules this on another day? If the latter, then you wouldn't be able to use the E/M code. I couldn't find any other specific guidelines online or in your book. Otherwise, I found a code in the old coding book. I tried looking it up on line, but it doesn't say anything different and I can't find any other guidelines - 69145 Excision soft tissue lesion, external auditory canal. The definition for a granuloma doesn't specifically call it this, but it sounds similar. You might want to check with your carrier on this code to see if they would prefer this one over the 92502/92504. I don't think the 69990 surical microscope would qualify to be used in this case, check it out anyway. I believe the surgical microscope is used for much more minute procedures, but you never know about the carrier. It might be that you can use the 92504 and 69145 together plus the scope?

By the time I got to the car I realized we might be totally off on this, but nevertheless, do some more research, check it out with an auditor for your major carrier just to see what they say. More than likely the others will be the same except maybe Medicare/Medicaid. Good luck with your doctors. If you have what the insurance carrier wants you to submit, you should be able to convince your manager/doctors that these are the proper codes to use and do they want to pay back all this money? I don't think so. Who knows, they might actually get paid more. Good luck. I loaned out my 2013 CPT, but I will see if I can find one at school and keep looking for you. Let me know which ones you end up using. I like to give the students good practice. It was really good to meet you today. Until the next time.

Tamara Hanson CPC
MAA/MIBC Instructor/Everest Institute
tamarahanson@wildblue.net (home)
thanson@cci.edu (work)
210-347-0621 cell
210-732-7800 x 212 work

 

[Jec290]

Can a 92502 be used by the facility. Our outpatient surgery center states that they can not bill a 92502 because it is a physician code. Is this true? I was thinking that a modifier needed to be used.
Please help!!