Otolaryngology Coding Alert

Coding for cerumen removal involves varying strategies depending on the scenario. Removing earwax (cerumen) is among the smallest-value services that otolaryngologists provide, yet because it is done frequently and can be time consuming, practices are losing out financially.

There are three main scenarios when the otolaryngologist will remove cerumen, says Kim Pollock, RN, MBA, an otolaryngology coding and reimbursement specialist in Dallas, TX:

1. Earwax removal in conjunction with a hearing test, or audiogram;

2. Cerumen removal alone with the use of a scope (Sometimes a primary-care physician will remove cerumen simply by washing out the ear, but if the impacted
cerumen requires intervention by an otolaryngologist, the scope is likely to be used.);

3. Cerumen removal during an examination.
According to Pollock, who conducts coding seminars for Karen Zupko and Associates, a Chicago, IL-based physician practice management consulting firm, each of these three scenarios involves different coding strategies.

1. Same day as hearing test. There is nothing in CPT 1999 that prohibits otolaryngologists from billing cerumen removal (69210, removal of impacted cerumen [separate procedure], one or both ears) on the same day as an audiogram (92557, comprehensive audiometry threshold evaluation and speech recognition), Pollock says. However, Medicare will not pay for the two together. According to the National Correct Coding Initiative (NCCI), cerumen removal is bundled into the hearing test, says Gretchen Segado, CPC, assistant compliance officer at Jefferson University in Philadelphia, PA, despite the fact that removing earwax can take as long as half an hour using sophisticated equipment. Medicare says a hearing test cannot be performed if the patients ears are full of wax. Therefore, Medicare considers the cerumen removal a necessary component of the hearing test if the patient requires it.

Still, Pollock advises her clients to report both procedures. Even though Medicare wont pay for the cerumen removal separately, many private carriers will. When Medicare denies the 69210 on the explanation of benefits (EOB), she recommends adjusting that charge off to a disallowed adjustment code and posting the payment for the audiogram.

2. Office scope cant be billed. In most cases, otolaryngologists will use a scope for removing earwax. However, whether the scope is used or not, the only procedure that may be billed is the cerumen removalcode 69210.

Billing for 92504 (binocular microscopy [separate diagnostic procedure]) is not appropriate, because 92504 is a separate procedure.

Note: Although the 92504 has fewer RVUs (0.6) than removal of cerumen, these are valued into code 69210, so 92504 cannot be billed separately.

This may frustrate some otolaryngologists because removal of cerumen can be a difficult, time-consuming and delicate procedure.

But Pollock says that if physicians were to bill for all incidences of [...]