Pediatric Coding Alert

Question: We recently administered an otoacoustic emissions test (OAE) on a one-year-old patient. Before the test, our pediatrician removed impacted cerumen from the patient’s ear. Can we bill for both services?

Virginia Subscriber

Answer: According to both the National Correct Coding Institute (CCI) and Medicare, the answer is no.

OAE tests such as 92587 (Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report) or 92588 (…comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report) have a 0 modifier indicator, meaning that they cannot be billed under any circumstances as a column 2 code when the cerumen removal codes 69209 (Removal impacted cerumen using irrigation/lavage, unilateral) or 69210 (Removal impacted cerumen requiring instrumentation, unilateral) are the column 1 codes.

However, NCCI Policy Manual for Medicare Services, Chapter XI H.6, states “removal of cerumen by an audiologist prior to audiologic function testing is not separately reportable. If the cerumen is impacted, cannot be removed by the audiologist, and requires removal by a physician, the physician may report HCPCS code G0268 (Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing) (XI.H.6) (Source: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/). CCI does not classify either of the OAE tests as Column 2 codes for G0268.