Otolaryngology Coding Alert

Question: A patient presented with a left ear canal 9 cm vascular lesion. After debridement of the skin over and surrounding the lesion, the surgeon cauterized the lesion with bipolar forceps. The surgeon suggests I bill for codes 69145 for the procedure and 92504 for the use of a microscope examination, but I am not sure if this is correct. How should I code this encounter?

Arkansas Subscriber

Answer: Since the surgeon used cautery to destroy the lesion, the application of code 69145 (Excision soft tissue lesion, external auditory canal) would be incorrect. If the surgeon surgically excised the lesion from the ear canal without the use of electrosurgery, you would be correct in applying code 69145.

Instead, you will want to apply code 17106 (Destruction of cutaneous vascular proliferative lesions [eg, laser technique]; less than 10 sq. cm) since the size of the lesion is below 10 sq. cm. Additionally, you will apply code 92504 (Binocular microscopy [separate diagnostic procedure]) for the microscope examination.

Note: Make sure that your physician documents the use of the binocular microscopy and any findings. Keep in mind that 92504 is a diagnostic examination of the ears. It does not describe the assistance of the microscope in performing this procedure. There is a chance that the payer may deny 92504 because of the "Separate Procedure" designation.