# debris/pus removed under microscope



## Lainie0559

How would you code debris/pus removed from the external auditory canal with a microscope?  

Can you use 92504?  Any suggestions would be greatly appreciated.


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## dimmitta

I have used 92504 for this before, there really isn't many other options. If you hear of a different code I would be interested to know what it is!


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## RonMcK3

*Cleaning/Debridement of External Ear*

Shouldn't the cleaning/debridement come from 69200-69222 (Auditory System-External Ear-Removal) with an add-on of 69990 for the microscope? CPT's description for 92504 says that it is a diagnostic procedure.


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## dimmitta

That's a good question. But is the pus a foreign body? If not then 69200 and 69205 cannot be used. The pus is not impacted cerumen either so 69210 cannot be used. And the mastoid cavity is not what was being debrided, therefore 69220 and 69222 cannot be used. I agree that is the general area the correct cpt _should_ come from but as you see there is no clear code for this. 

I agreed with 92504 because it is diagnositic. The physician would be using a microscope to examine the ear canal, I assume, to determine the cause of the pus/debris. During the diagnostic process he would have to clear the area to get an idea of what should be done next to prevent recurrence. Will the patient need ear tubes? Is there a perforation? Is there a lesion infected causing the pus/debris? With no other clear code this seems the best way to capture the service provided.

Of course, this is all conjecture, having not seen the op report  Only a best guess based on years experience in this specialty


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## RonMcK3

Thanks for the detailed explanation. So, if pus isn't a foreign body, thereby ruling out use of 69200, (but we are in the right part of CPT) how about 69399 Unlisted procedure, external ear +69990 for the microscope? 

Thanks,


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## AngieH

I think 69200 would be the correct code. The description for 69200 states a foreign body is removed using delicate forceps, a cerumen spoon or suction. Pus would have to be suctioned out. Foreign body is something that doesnt belong, and I would consider pus to be a FB because it does not belong there.


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## mitchellde

Pus is not a foreign body since the body is creating it.  You might not like it and it is yucky but it is not foreign to the body.  I think a copy of the note is need to make any determination.


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## dimmitta

*FB?*

I'm not sure that pus should be considered a foreign body. I agree that pus should not be in the ear canal but it is more of a symptom of some other issue, such as an infection. Just my opinion 



AngieH said:


> I think 69200 would be the correct code. The description for 69200 states a foreign body is removed using delicate forceps, a cerumen spoon or suction. Pus would have to be suctioned out. Foreign body is something that doesnt belong, and I would consider pus to be a FB because it does not belong there.


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