# ?????CPT Coding Sequence????



## Rip (Sep 3, 2012)

I'm confused by reading CMS Rules & Guidelines....
When submitting claims for multiple surgeries do you sequence the codes by:
1.  By primary surgery, (then how do you determine sequence for additional surgeries)
2. RVU

I was told that I am to list the procedures by Highest RVU.  
In a discussion with another coder, she said that the order doesn't matter.

ALSO:  During office visit, E/M is reported first.  
If tests are performed, such as Audio, do you list them highest RVU first or 
does it matter how they are listed?

I can't find any specific easy to understand answers.............


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## michelleholt (Sep 3, 2012)

*CPT Sequence*

When coding a surgery, you will code the primary surgery first.  Then any add-on's that apply will come after the primary code.  If the pt. had two surgeries done on separate locations, (ex. knee surgery, then ankle) you would code knee first, then ankle with a modifer on the ankle surgery (code).  For E/M visit, always code the E/M level first, then any additional procedures after.  You want reimbursement for the E/M level, other procedures during an E/M visit can sometimes be inclusive.  Make sure you apply mod. 25 if a procedure such as ear irrigation is done.  Audio testing should be without a modifier, make sure you have an ICD-9 code to go with it.  Hope this helps.


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## hewitt (Sep 4, 2012)

Great suggestion! Also, especially for Medicare, make sure additional procedures are listed by high to lowest RVU. Medicare tends to pay (after primary procedures) about 50% for next highest CPTs, then 25% as they are listed.


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## mrdave (Oct 9, 2012)

michelleholt said:


> Make sure you apply mod. 25 if a procedure such as ear irrigation is done.



There isn't a code for ear irrigation in addition to an e/m code. The 69210 for "cleaning" the ear canal must be performed by the provider with visualization (with otoscope at minimum) and the use of instruments (curette, forceps, cerumen spoon, or micro-suction). 
A nurse visit can be scheduled for the irrigation and billed as a 99211.

Just for clarity


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