Binocular Microscopy

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:

CPT® code, 92504 binocular microscopy, (separate diagnostic procedure) may not be reported when the microscope is used to perform the minor ear procedures as described. Here is why!

92504 is a diagnostic procedure—as such the CPT® rules state that all surgical procedures include a 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  For example, a surgeon needs to use the microscope to examine a patient who has external otitis and places an ear wick. In this case, it is appropriate to report CPT® code 92504.