Otolaryngology Coding Alert

Question: Can I include an impacted cerumen removal code when it’s performed in addition to tube removal under general anesthesia on the same ear?

Nevada Subscriber

Answer: If you’ve already come across the National Correct Coding Initiative (NCCI, or CCI) edit between 69210 (Removal impacted cerumen requiring instrumentation, unilateral) and 69424 (Ventilating tube removal requiring general anesthesia), you’ll see 69210 bundles into 69424 unless you opt to use an overriding modifier. The question then begs, in what circumstance is an overriding modifier such as 59 (Distinct Procedural Service) or XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) applicable?

While these two procedures do technically indicate separate sites, you have to have a firmer understanding of what’s included in a ventilating tube removal before determining whether 69210 bundles into 69424. For a patient with impacted cerumen in the same ear as the tube removal, the surgeon would not be able to access the ventilating tube without first removing the impacted cerumen. You can view this under the same lens as a nasal endoscopy service that’s included a more comprehensive service. Specifically, consider the concept of “access regions.”

For example, you’ll notice that you can’t report code 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)) with 31276 (Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed) due to an NCCI modifier status of “0.” That’s because, as the NCCI Policy Manual explains, you’ve got to take into account access points, or regions:

“When a diagnostic or surgical endoscopy of the respiratory system is performed, it is a standard of practice to evaluate the access regions. A separate HCPCS/CPT^® code shall not be reported for this evaluation of the access regions. For example, if an endoscopic anterior ethmoidectomy is performed, a diagnostic nasal endoscopy shall not be reported separately simply because the approach to the ethmoid sinus is transnasal.”

Piggybacking off of this idea, you can see how billing separately for 69210 in addition to 69424 would be inappropriate. There are no instances when you should report 69210 alongside 69424 on the same ear.