Otolaryngology Coding Alert

Coding updates in 2010 will make you frown and smile. While two new audiology testing codes are not yet bundled with cerumen removal, common sense states that you should not report them together when an audiologist performs the removal. The septoplasty and ablation bundle, however, still allows payment when the ENT performs the procedures for different clinical reasons.

With the introduction of two new audiological testing CPT codes, be sure to realize that cerumen removal is still considered inclusive in audiological testing. Do not report 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) when an audiologist performs the removal along with the following newly released CPT codes:

• 92550 -- Tympanometry and reflex threshold measurements
• 92570 -- Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing.

The same rule applies when the audiologist removes impacted cerumen on the same date of service with other audiologic function tests 92552-92596, which are bundled with 69210 in the National Correct Coding Institute (NCCI) edits.

G code fact: Don't try to report HCPCS Level II code G0268 (Removal of impacted cerumen [one or both ears] by physician on same date of service as audiologic function testing); this code is not meant for audiologists, explains Robert C. Fifer, PhD, director of Audiology and Speech-Language Pathology at University of Miami's Mailman Center for Child Development. CMS created G0268 to allow payment to a physician who removes impacted cerumen when the patient is undergoing audiological testing on the same date. However, routinecerumen removal is considered to be integral to theaudiological procedure and not something that audiologists can report separately, Fifer concludes. CPT 69210 is also included in therapeutic procedures that audiologists perform and, thus, is not separately payable when reporting a therapeutic procedure on the same day of service.

Tip: If a physician performs wax removal on the same day that an audiologist performs testing, the physician's office may report G0268 for the service. If a physician performs wax removal when the patient does not receive audiological testing on the same day, report 69210 for the service.

You'll be glad about this AAO-HNS victory. In November 2009, Medicare proposed to change the CCI modifier indicator to "0" for 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and 30801 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method [eg, electrocautery, radiofrequency ablation, or tissue volume reduction]; superficial) to disallow reimbursement when the two were reported together on the same date of service, according to an AAO-HNS release (www.entnet.org/Practice/Performing-30520-and-30801-on-the-same-DOS.cfm). If finalized, this edit would have been effective from April 1, 2010.

Reasoning: AAO-HNS argued to Medicare that inferior turbinates and the septum are anatomically independent structures within the nose and each may contribute to airway obstruction. Clinically, the work of 30801 is not part of septoplasty, stated the release.

Example: If an ENT performed both 30520 and 30801 on the same date of service, states the AAOHNS, it would generally be to correct separate causes of obstruction, for example:

• septal deviation (470) by means of septoplasty (30520), and
• obstructive inferior turbinate hypertrophy/hypertrophic rhinitis (478.0) with ablation (30801).

Medicare agreed and will allow you to append an appropriate modifier, such as 59 (Distinct procedural service), to show both services were different and separate. When warranted, append 59 to 30801, the column 2 code. "One typically reports the code of lesser value (and which might generally be considered inclusive) second, with the modifier appended or attached," notes Richard Waguespack, MD, FACS, practicing otolaryngologist in Birmingham, Ala. and committee chair with AAO-HNS.

While you may think that no modifier should be necessary for this code pair, Medicare wants to avoid physicians reporting 30801 when using ablation for access or hemostasis. To clarify, do not report 30801 with 30520 if the cautery/ablation of the inferior turbinates is for the purpose of controlling bleeding due to the procedure described by 30520.

What to do: Link different diagnosis codes to 30520 and 30801 (such as 470 and 478.0, respectively).

Note: Another common ablation code, CPT 30802 (Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method [e.g., electrocautery, radiofrequency ablation, or tissue volume reduction]; intramural [i.e., submucosal]), is not bundled with 30520.