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Otolaryngology Coding Alert

Reader Question:

Stick With E/M for In-Office Tube Removal

Question: My otolaryngologist removed a tympan-ostomy tube that was placed by another otolaryngologist who is outside our practice. Should I bill for the removal, which the ENT performed without general anesthesia? Illinois Subscriber Answer: No CPT code exists for removing a pressure- equalizing tube that a physician removes without general anesthesia. Because no code describes this procedure and CPT disallows reporting codes that approximate a procedure, you should instead consider the removal part of the E/M service. Therefore, instruct the otolaryngologist to include the removal work when selecting the level of E/M service that he is reporting for that encounter, such as 99201-99215 (Office or other outpatient visit). The removal presumably occurs in the office because the it does not require general anesthesia. Procedures requiring general anesthesia usually take place in an operating room. If the physician must use binocular microscopy to aid in tube removal, you may report 92504 (Binocular microscopy [separate diagnostic procedure]). To report an E/M service in addition to the microscopy, you must make sure documentation shows that the otolaryngologist performed a significant, separate service from the minor E/M included in the procedure. If so, append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the service code. Pay attention: For removal of a PE tube under general anesthesia, use 69424 (Ventilating tube removal requiring general anesthesia).

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