Part B Insider (Multispecialty) Coding Alert

Published on Fri Sep 27, 2013 PDF

Question: The physician used suction and cup forceps to debride an ear canal lesion (the procedure did not require sutures). He obtained hemostasis with phenylephrine or silver nitrate. The operating microscope was used. What should I code for this procedure?

Nebraska Subscriber

Answer: There is no procedure code for debridement of the external ear. The only debridement code that is in the area of the external ear involves debridement of a mastoidectomy cavity, which means the patient would need to have had a prior mastoidectomy before a physician could perform a mastoidectomy debridement (69220, Debridement, mastoidectomy cavity, simple [e.g., routine cleaning]). If the patient has not had a prior mastoidectomy, you cannot report 69220 for the debridement. Experts recommend considering two options.

Only code for the binocular microscopy that was used. Since 92504 (Binocular microscopy [separate diagnostic procedure]) is a separate procedure, you cannot bill 92504 in addition to another ear CPT® code. You can only code and bill 92504 if you do not code any other ear procedure code.

Report 69399 (Unlisted procedure, external ear). Submitting 69399 probably would require an appeal with the procedure note and explanation of the unlisted procedure for the payer, including some other CPT® codes the payer can refer to for comparative work values. For example, if the work for this debridement was similar to what your surgeon would have expended for a mastoidectomy debridement, compare your unlisted procedure to 69220 for pricing. If this debridement was ¾ of the work, effort, and risk involved in a mastoidectomy debridement, you can use 69220 as a reference and inform the payer that your unlisted service is equal to ¾ of 69220 in work, risk, and effort for pricing purposes.