EM Coding Alert

Question: I have a provider who uses an operating microscope to debride the ear canal of “desquamated skin/debris” and “mucopus.” Is there a code that is appropriate to bill for these cases?

AAPC Forum Participant

Answer: Actually, there is no procedure code for debridement of the external auditory canal (EAC). The only debridement code that is in the area of the EAC involves a mastoidectomy cavity: 69220 (Debridement, mastoidectomy cavity, simple (eg, routine cleaning)). However, it wouldn’t be appropriate to bill 69220, as the otolaryngologist is performing debridement of the ear canal.

You’ll also want to avoid using a code such as 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface), as the intent of this code is not for use in the ear canal. Instead, consider these two options:

Code for in-office binocular microscopy: Because of the separate procedure designation, you should report 92504 (Binocular microscopy (separate diagnostic procedure)), but only when the provider performs no other related ear procedure during the same visit or if no code exists for the procedure performed. You may report 92504 with an evaluation and management (E/M) code, assuming your documentation supports it.

Code for an unlisted procedure: You may also be able to report 69399 (Unlisted procedure, external ear). However, submitting 69399 probably would require an appeal with the procedure note and explanation of the unlisted procedure for the payer, including some other CPT® codes the payer can refer to for comparative work values.

For example, if the work for this debridement was similar to what your surgeon would have expended for a mastoidectomy debridement, compare your unlisted procedure to 69220 for pricing. If the debridement involved 75 percent of the work involved in a mastoidectomy debridement, you can use 69220 as a reference and inform the payer that your unlisted service is equal to 75 percent of 69220 in work, risk, and effort for pricing purposes.