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Otolaryngology Coding Alert


Sub Care Leads to I&D: 1 Code or 2?

Question: An otolaryngologist admitted a 10-year-old boy to the hospital for acute right neck lympha-denitis that was unresponsive to oral antibiotics. I coded the admission as 99222 and five days of subsequent hospital care.

On day 6, the lymphadenitis had become an abscess, so the otolaryngologist performed an incision and drainage (I&D), which I coded as 21501 (90-day global period). Can I charge a subsequent hospital visit in addition to the I&D?

South Carolina Subscriber

Answer: If the otolaryngologist documented the decision for the surgery based on a history, examination and medical decision-making on day 6, yes, you should bill the follow-up hospital care in addition to the I&D (21501, Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax).

To indicate that the E/M was a decision for surgery, append the subsequent hospital care code, such as 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient -), with modifier 57 (Decision for surgery).

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