November Coding Tips

** Here's the buzz for November -- Cerumen Removal(s) and also a quick update on Obsteteric U/sounds trans-vag and trans-abdominal... Enjoy....

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Cerumen Removal (69210)

Here is the guidance from CPT-

A major element in determining whether code 69210 should be reported is understanding the definition of impacted cerumen. By definition of the AAO-HNS,

“If any one or more of the following are present, cerumen should be considered ‘impacted’ clinically:

Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.

Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc.

Inflammatory considerations: Associated with foul odor, infection, or dermatitis.

Quantitative considerations: Obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations requiring physician skills.”

Other issues may also require consideration. Removing wax that is not impacted does not warrant the reporting of CPT code 69210. Rather, that work would appropriately be captured by an evaluation and management (E/M) code regardless of how it is removed. If, however, the wax is truly impacted, then its removal should be reported with 69210 if performed by a physician using at minimum an otoscope and instruments such as wax curettes.

To summarize:

• Only bill for cerumen removal if the cerumen is impacted and there is provider involvement in the removal.
  
  
• If the patient returns at a later date for an ear irrigation performed by the nurse only, a 99211 nurse visit code should be billed.

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Billing for Transvaginal and Transabdominal Ultrasound on OB patients at the same session

Per CPT Ultrasound Guidelines: “If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam, use 76817 in addition to appropriate transabdominal exam code”.

When reporting multiple modalities, and expecting to receive reimbursement,the clinical indications are usually the determining factor if the claims will be reimbursed. Most payers will pay this coding combination when the following criteria have been met:

There must be a clinical indication as to why both modalities are warranted and the diagnosis codes must be linked accordingly.

Example : Complete and Detailed Ultrasound (CPT 76811) was performed due to suspected fetal anomaly OB Transvaginal Ultrasound (CPT 76817) was performed during the same session to evaluate the characteristics of cervix including length and structure for a patient with cervical incompetence.

 The documentation must clearly define that both modalities were utilized.

Example : “In addition to the transabdominal approach, a transvaginal ultrasound as utilized to access the cervical length”.

According to Medicare National Correct Coding Policy Edits, October – December 2010 (Version 16.3), there are no current “bundling” edits in place that would not allow payment for both services. However…..some payers may require that the Modifier 59 Distinct Procedural Service) be attached to the transvaginal study when billed in conjunction with a transabdominal study.

Example :

76811 & 76817- 59 Or 76811- 26 & 76817- 26 - 59

If you are unsure about payment, always call the 3rd party payer (insurance carrier) regarding their policy of a specific CPT code and/or diagnosis.