Otolaryngology Coding Alert

Question: I billed G0268 with 92511 and had the appropriate documentation for support. One of our private payers denied the G0268 because the “related qualifying service” (Audiologic Function Testing) wasn’t billed for the same date of service. I didn’t realize you needed an audio evaluation to bill G0268. Has something changed with the codes? 

West Virginia Subscriber 

 Answer: Yes, that is why G0268 (Removal of impacted cerumen [one or both ears] by physician on same date of service as audiologic function testing) was introduced. It shows that the audiologist did not remove the cerumen when cerumen was removed on the same day that audiology services were performed. 

Also note: In the past, you reported audiology services on the same claim form as physician services (such as 92511, Nasopharyngoscopy with endoscope [separate procedure]). Now the audiology goes on a separate form since the audiologists bill under their own NPI numbers.

If your doctor removed impacted cerumen, appeal the claim with 69210 (Removal impacted cerumen requiring instrumentation, unilateral) for the procedure.