Wiki Cerumen Removal and Foreign Body

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dballard2004

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How would a provider correctly code an encounter for both a cerumen removal and a foreign body removal from the ear when irrigation curettage. Would it be the same CPT only or would they use the CPT and an E/M with -25 appended? Am I correct that if a foreign body is removed without an incision, that it falls under the E/M code?
 
CPT assistant says for foreign body:

CPT Lay Descriptions

69200-69205 (69200, 69205)

Under direct visualization, the physician or technician removes a foreign body from the external auditory canal using delicate forceps, a cerumen spoon, or suction. In the case of a live insect, oil is dropped into the ear to immobilize it before it is removed. No anesthetic or local anesthetic is used in 69200. If a child or an adult cannot tolerate the procedure while awake, it is performed under general anesthesia in 69205. Code 69205 is also reported in cases where the foreign body is so large, an incision is made in the external meatus to enlarge the opening before the foreign body can be extracted.

My opinion is that since you would use the same type instruments to remove the foreign body as you do the cerumen and since cerumen is considered "separate procedure" you would only report the 69200. This is in the NCCI edit list with a 1, but my thinking is that if you do one ear for foreign body and the same ear for impaction cerumen removal, then it's considered inclusive so 69200. If you do both ears cerumen impaction removal (69210)and one ear foreign body removal (69200), then you could justify both codes with a 59 modifier on the 69210. I also ran this through our 3M and it flags you and says 69200 is considered a comprehensive code.

Good luck!
 
dballard2004 said:
How would a provider correctly code an encounter for both a cerumen removal and a foreign body removal from the ear when irrigation curettage. Would it be the same CPT only or would they use the CPT and an E/M with -25 appended? Am I correct that if a foreign body is removed without an incision, that it falls under the E/M code?
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You are correct that most foreign body removals require an incision; however, 69200 does not. For those codes that do require an incision and an incision isn't the method of removal, the guidelines do direct you to an E/M code. As for 69200, the CDR states that the removal technique could be forceps (tweezers), a curette spoon, or suction. I do agree with Anna that if both procedures are for the same ear, I would only bill 69200 w/ ICD-9 code 931 since 69210 is listed as a separate procedure. Also, the RVU's for 69200 are slightly higher. If your documentation can support a separate, identifiable E/M, this would be reportable, also (w/ mod 25).
 
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