Although otolaryngologists welcome the new cerumen removal code (G0268), Medicare reserves the code for nonroutine physician wax removal only. Cerumen removal, fiberoptic endoscopic evaluation of swallowing (FEES), fiberoptic endoscopic evaluation of swallowing with sensory testing (FEEST), and speech G codes are only some of the numerous topics discussed in the preamble to the National Physician Fee Schedule Relative Value File for 2003.
In addition to clarifying how to use the new HCPCS code for cerumen removal, CMS'new Physician Fee Schedule provided the following:
granted no physician work relative value units (RVUs) to FEES and FEEST codes (92610-92611) and the codes for report and interpretation only (92613, 92615, 92617)
made two postoperative cochlear implant codes (92605 and 92606) bundled codes
announced erroneous noncoverage of an aural rehabilitation code (92510)
replaced many speech G codes with CPT codes. Use New G Code for Nonroutine Cerumen Removal The
Fee Schedule 's preamble discusses a new HCPCS level-two code for physician cerumen removal: G0268 (Removal of impacted cerumen [one or both ears] by physician on same date of service as audiologic function testing). Medicare previously assumed that an audiologist always performed cerumen removal and considered the procedure integral to an audio, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. "CMS created the new code to reimburse doctors for complicated impacted cerumen removal that requires a physician's skill."
Consider the code the cerumen-removal equivalent of 36410* (Venipuncture, child over age 3 years or adult, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture). You would report 36410 only when the procedure requires a physician's skill. Similarly, you should report G0268 only when cerumen removal is too complicated for the audiologist to perform, meaning it is truly impacted, so the otolaryngologist must perform the procedure, Cobuzzi explains. For a simple wash performed to get a valid audiology test, you should not use G0268. For example, an established patient complains of coughing, sneezing, fatigue and achiness. The otolaryngologist takes a history and examination and uses medical decision-making. He diagnoses acute sinusitis, removes impacted cerumen from the patient's ear canal and sends the patient to the audiologist for pure tone air audiometry. You should report all three services and procedures. For the office visit, report 99211-99215 (Office or other outpatient visit for an established patient) appended with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to indicate a significant, separately identifiable service. For the cerumen removal, assign G0268. For the audiometry, use 92552 linked to the diagnosis [...]
