Practice Management Alert

Lavage/irrigation get their own code in 2016.

Physician practices that perform cerumen (earwax) removal and/or vaccinations are in for a treat when 2016 rolls around.

Reason: CPT^® 2016 will debut a new code for less involved forms of cerumen removal, which will eliminate the need to consider certain removal techniques part of a standard evaluation and management (E/M) service. Further, the latest coding manual will include several new codes for vaccinations.

Read on to get the skinny on the new codes that could affect your bottom line if your practice performs cerumen removal or vaccinations.

Use 69209 for Some Cerumen Removals

Before 2016, CPT^® always contended that you must have documentation proving the cerumen was impacted before you could submit a procedure code; typically, that code was 69210 (Removal impacted cerumen requiring instrumentation, unilateral).

If the cerumen wasn’t impacted, or if the physician didn’t use any type of instrumentation during the removal, you’d include roll the service into an E/M code such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making…).

CPT^® 2016 will change that with new code 69209 (Removal impacted cerumen using irrigation/lavage, unilateral).

Irrigation or lavage is standard practice at many physician practices. “It is basically what primary care doctors do to remove cerumen,” explains Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CENTC, CPCO, vice president of the coding and consulting division of J. & S. Stark Billing & Consulting, Inc., in Shrewsbury, N.J. 

Important: Physicians will have to demonstrate that they provided a significant and separately identifiable E/M service (represented by modifier 25) in order to bill an E/M and the new code 69209 if it is not status B (bundled) in the payer’s fee schedule. “Once the insurers release their fee schedules, it will be important to determine whether 69209 has a status of B, meaning that it’s bundled with the E/M and therefore cannot be reported separately,” says Cobuzzi.

Consider 69210 If Cerumen Is Impacted

If the physician removes clinically impacted cerumen from an established patient’s ear using instrumentation, you should still report 69210 for the procedure in 2016.

Long story short: If the physician isn’t involved in the cerumen removal, then you can forget about 69210. By definition, impacted cerumen requires a physician’s skill to remove. Payers might consider cerumen impacted if it is impairing a patient’s external auditory canal, tympanic membrane, or middle ear. Impacted cerumen is typically very hard and dry, and often causes pain or itching to the patient.

As the code descriptor indicates, the physician must also use instrumentation for you to be able to code cerumen removal with 69210. Instrumentation the physician might use includes, but is not limited to, suction, probes, forceps, curettes, and right angle hooks.

If the provider removes non-impacted cerumen from a patient’s ear, you should report the new code 69209 or the appropriate-level E/M code, depending on encounter notes.

Note These Changes to Vaccine Codes

As with every year, physician practices will also see some changes to vaccine codes in CPT^® 2016. You will have to add four new vaccine codes to your kitty while making note of many changes to the descriptors of old codes.

The four new codes that you will see in 2016 include:

• 90620 (Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B [MenB], 2 dose schedule, for intramuscular use)
• 90621 (Meningococcal recombinant lipoprotein vaccine, serogroup B [MenB], 3 dose schedule, for intramuscular use)
• 90625 (Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use)
• 90697 (Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine [DTaP-IPV-Hib¬-HepB], for intramuscular use)

In addition, you will see descriptor changes to many of the vaccine codes that you may use in your practice. Also, you will see some of the old codes disappearing when CPT^® 2106 comes into effect.