The Otolaryngology Coding Coach 2003 Archives

Question:

We live in a small community and the physician will be called into the hospital to see a patient in the emergency room. Can he bill for reading this CT scan?

Answer:

The short answer to your question is “yes” but We think you'll want to take into account a few variables.

If the physician orders the CT scan, reads the CT scan and treats the patient based on his/her interpretation Medicare says the physician may report the professional interpretation with a -26 modifier (professional component).

However, the physician needs to ensure the radiologist is not going bill for the interpretation. Ask the physician to check with the medical staff office to make sure that his/her credentialing privileges include reading x-rays. If the otolaryngologist is credentialed to read x-rays at the hospital, the answer is yes, and the modifier 26 is appended to the appropriate CPT code. The physician must dictate a separate radiology interpretation (similar to the radiologist report) if s/he is billing for the professional interpretation. You'll also want to check with your malpractice/liability carrier to make sure you are covered for formal radiological supervision and interpretation services. Many carriers will not cover surgeons performing radiology services.

Question:

Our physicians want to report binocular microscopy in addition to minor ear procedures when they use the microscope in the office. For example, removing ear wax or placing tubes, and mastoid debridements. Can binocular microscopy be reported in addition to the minor procedure codes? Their documentation supports the use of the microscope.

Answer:

The answer is no, 92504 binocular microscopy, (separate diagnostic procedure) may not be reported when the microscope is used to perform the minor ear procedures as you identified. But let’s talk about the why’s!

92504 is a diagnostic procedure—as such the CPT rules state that all surgical procedures include the diagnostic procedure

92504 is listed as a “separate procedure”—as such, CPT rules state “Some of the procedures or services listed in CPT that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term “separate procedure.” The codes designated as “separate procedure” should not be reported in addition to the code for the total procedure or service of which it is considered an integral component (CPT Assistant, 1998)

When can it be reported? 92504 may be reported when the physician is performing a diagnostic otologic exam that requires the use of the microscope because the examination or service cannot be performed with the otoscope

Remember, 92504 is a diagnostic CPT code, not a therapeutic code