92504 and E and M coding

I am an ENT and frequently need the microscope to visualize or instrument the ear canal. Can I also use an E and M code ? For example, I may suction an ear to treat otitis externa or I may clean skin out of an unimpacted ear. Do I just use the 92504 or can I also code for E and M ?
Thanks,
David Mann MD

re: 92504 and E and M coding

Per AMA CPT® book, 92504 is a Special Otorhinolaryngologic Service and therefore is not included in an E&M service. It is a separate diagnostic procedure and so if you do bill for an E&M service, which you would document of course, than you would need to append a 25 modifier on the E&M code.