Otolaryngology Coding Alert

Otolaryngology practices can breathe easier now that the Correct Coding Initiative (CCI) has reversed the repair of nasal vestibular stenosis (RNVS) bundle with rhinoplasty and septoplasty. Other changes in CCI include bundling cerumen removal in more codes.

CCI 8.2, effective July 1, 2002, reverses its bundling of the lower-RVU (relative value units) valued 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) in the higher-valued nasal vestibular stenosis (30465, Repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction). When performing both procedures, practices can now report the higher-paying RNVS (30465).

Similarly, the edits changed lower-RVU 30400 (Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip) from a comprehensive of higher-RVU 30465 to a component of 30465, the comprehensive code. When both 30400 and 30465 are performed, you can assign the higher-RVU 30465.

CCI also deleted its bundle of 30465 with rhinoplasty codes 30460 (Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only) and 30462 ( tip, septum, osteotomies) and septoplasty code 30620 (Septal or other intranasal dermatoplasty [does not include obtaining graft]). CMS had considered 30465 mutually exclusive "procedures or services that could not reasonably be performed at the same session by the same provider on the same beneficiary" of the rhinoplasty and septoplasty codes.

Continuing the trend to include cerumen removal as a necessary medical tool prior to treatment, CCI 8.2 bundles several otorhinolaryngologic services with 69210 (Removal impacted cerumen [separate procedure], one or both ears). The edits make cerumen removal a component of the otolaryngologic examination (92502), the evaluation (92506) and treatment of speech (92507-92508), and the aural rehabilitation following cochlear implant (92510). The caloric vestibular test with recording (92543) also includes cerumen removal (69210). Because CCI denotes these edits with a modifier indicator of "0," you cannot use a modifier to unbundle the code sets.

CCI 8.2 also adds several auditory system codes, including complete external ear amputation (69120), eustachian tube catheterization (69405), focal application of phase control substance (69410), middle ear incision and tympanostomy (69420-69450), excision of aural polyp or tumor (69540-69550) and tympanic repair or tympanoplasty (69610-69676) to its list of procedures that include cerumen removal. Despite the extensive additions, these edits contain a modifier indicator of "1," which means certain circumstances may justify using a modifier.

For instance, an otolaryngologist performs an audiogram, e.g., 92552, Pure tone audiometry (threshold); air only. During the procedure, the patient complains of stuffiness in the hearing in his right ear, and the doctor spends 20 minutes removing a significant amount of wax from that ear. Removal requires multiple scrapings and microscopy. Because the cerumen removal constitutes a separate procedure, you should report both procedures and append modifier -59 (Distinct procedural service) to the lesser-valued code (69210).

Or perhaps a patient presents for tympanostomy on the right ear, and the doctor removes cerumen from both ears. Report 69436-RT (Right side), 69210-59-LT (Left side).