ED Coding and Reimbursement Alert

Question: One of our physicians inserted an ear wick saturated with an antibiotic into a patient's ear to reach an infection in the right inner ear. How should I report the procedure?

Oklahoma Subscriber
 
Answer: When your physician has to insert and/or remove an ear wick, there is no code to represent the specific procedure; the ear wick insertion is bundled into whatever code you are reporting for the encounter.

When the physician performs only the insertion but no other procedure, then the payer considers the ear wick insertion part of the evaluation and management service. Suppose the procedure notes indicate a level-two E/M service. On the claim, you would:

- report 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision- making of low complexity) for the E/M.

- attach 380.10 (Infective otis externa, unspecified) to 99282 to provide medical necessity for the E/M service. The ED physician may also perform ear wick insertion while performing an ear drainage (e.g., 69000, Drainage external ear, abscess or hematoma; simple; or 69020, Drainage external auditory canal, abscess). In these scenarios, the wick insertion is bundled into the drainage code. Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI, an ED coding and billing company in Woburn, Mass.