Otolaryngology Coding Alert

Pay special attention to cerumen removal services.

With more than 57,000 Correct Coding Initiative (CCI) edits going into effect on Jan. 1, 2016, it’s not surprising to see many otolaryngology procedures affected by the update. Read on for the most important changes for your day-to-day coding.

Report Caloric Vestibular Tests Instead of Other Procedures

CPT^® 2016 introduces three new codes that represent ENT procedures, which means they’re fair game for being part of CCI edit pairs.

Two of the ENT codes, 92537 (Caloric vestibular test with recording, bilateral; bithermal [i.e., one warm and one cool irrigation in each ear for a total of four irrigations]) and 92538 (… monothermal [i.e., one irrigation in each ear for a total of two irrigations]), are considered the Column 1 code when performed with several specific procedures. File with 92537 or 92538 instead of:

• 36591 (Collection of blood specimen from a completely implantable venous access device) or 36592 (Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified)
• 69209 (Removal impacted cerumen using irrigation/lavage, unilateral) or 69210 (Removal impacted cerumen requiring instrumentation, unilateral)
• G0268 (Removal of impacted cerumen [one or both ears] by physician on same date of service as audiologic function testing).

“The edits involving 69209 and G0268 are because CMS does not want to pay for the removal of cerumen which allows access for the vestibular testing,” explains Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, vice president at Stark Coding & Consulting, LLC, in Shrewsbury, N.J.

Also note that the edits specify that 92537 includes the work of 92538 since 92538 (2 irrigations) is included in 92537 (4 irrigations).

Double Check Cerumen Removal Pairings

Both codes for cerumen removal (69209 and 69210) are listed in CCI 22.0 as the Column 1 procedure in more than 200 edit pairs. The bundled procedures range from simple wound repair and nerve injections to extended breathing tests and EEG monitoring. Most represent situations when your physician probably would not be performing both procedures during the same encounter, but take a look at the pairings just to be aware.

Switch up: The role of 69209 changes when paired with most audiologic function tests (92550-92596). In these edits, cerumen removal is bundled into the test procedure so should not be reported separately. The same holds true when your physician wants to report 69209 with auditory function tests (92620-92627): report the test, not the cerumen removal since audiologic function testing and auditory function testing cannot be performed without first cleaning out the patient’s accumulated cerumen in the ear.

Exception: Cochlear implant test codes 92601-92604 are not part of the 69209 edits. If your provider uses lavage to remove cerumen when performing a cochlear implant test, you should be able to submit both codes if you have sufficient documentation of each service.