Pediatric Coding Alert

Keep your ear to the ground to spot these FBRs.

Coders at pediatric practices will often face encounter forms that involve a foreign body removal (FBR).

Providers that perform foreign body removals (FBRs) need to have coders that know you cannot report the standard FBR codes — 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (… complicated) — for ear FBRs.

The key to mastery when coding these claims comes from knowledge of each type of ear procedure your provider might perform.

Here’s a look at how to code some FBRs you won’t find in the patient’s subcutaneous tissue.

Remember to Use These Ear FBR Codes

CPT® contains a code pair for external auditory canal FBRs: 69200 (Removal foreign body from external auditory canal; without general anesthesia) and 69205 (… with general anesthesia).

What qualifies as an ear FB? Just about anything that’s not supposed to be there. “Anything other than normal parts or secretions of the ear are considered foreign bodies,” explains Beth Adams, billing manager at Advocare ENT Specialty Center in Marlton, N.J. “The foreign body does not have to be a certain size or depth.”

FB examples: “Hearing aid piece, bugs, beads, food, cotton, pencil erasers, buttons, beans, etc.,” says Lisa Jones, CPC, consultant at 360 Practice Management Solutions in Hollywood, Fla.

Non-FBs: “Skin debris, cerumen, cholesteatomas, abscesses, etc., are not foreign bodies,” Jones continues.

Also, keep in mind that something the pediatrician places in the patient’s ear, such as a tube, does not qualify as an FB.

Clues: During a 69200/69205 service, the provider would likely use a combination of the following instruments and supplies, Adams says: hook, curette, cerumen loop, forceps, right-angle ball hook, or suction. The pediatrician may also use the binocular microscope to assist in finding the foreign body.

Although this is a separate procedure with its own code, it is not separately codable when reporting 69200 or 69205.

And, of course, the provider might also use general anesthesia, which would lead you to choose 69205.

Bug in your ear? Jones says that when a person has a living ear FB, such as a bug, the provider might need to use oil drops to immobilize it before removal.