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.
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.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.”
So what are those requirements?
Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.
Implants could be considered ...
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...