Pediatric Coding Alert

Plus: CPT® 2016 will debut new x-ray codes for scoliosis evaluations.

As most pediatric coders are aware, payment for cerumen removal doesn’t come easily. You have to document the fact that the cerumen was impacted and required the physician to use instrumentation to remove it before you can report 69210 (Removal impacted cerumen requiring instrumentation, unilateral). And if the physician uses irrigation or lavage to remove the cerumen, you have to include that service in your E/M code for the visit. However, that could all change starting this January.

CPT^® 2016 will include new code 69209 (Removal impacted cerumen using irrigation/lavage, unilateral) to describe instances when the physician (or staff) removes cerumen but does not use instrumentation. As with the other removal this procedure still has to be documented.  Unfortunately, it’s unclear whether insurers will assign any payment amounts to the code, but many coders are optimistic about the potential of the new code.

Once the insurers release their fee schedules, it will be important to determine whether 69209 has a status of “B,” meaning that it’s bundled with the E/M and therefore cannot be reported with an E/M visit, says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CENTC, CPCO, vice president of coding and consulting division with J&S Stark Billing and Consulting, Inc. in Shewsbury, NJ. “Primary care doctors will have to demonstrate that their E/M is significant and separately identifiable (25 modified) in order to bill an E/M and the new code 69209 if it is not status B,” she advises.

Keep in mind: Both codes use the word “unilateral,” which means that if you remove cerumen on both ears, you’ll have to append modifier 50 (Bilateral procedure) to the code.

Scoliosis X-Rays Will Change

CPT^® 2016 also aims to alter the way you report x-rays for scoliosis evaluations. Currently, you typically report 72010 (Radiologic examination, spine, entire, survey study, anteroposterior and lateral), 72069 (Radiologic examination, spine, thoracolumbar, standing [scoliosis]) or 72090 (Radiologic examination, spine; scoliosis study, including supine and erect studies) for this service, particularly when you suspect that patients have scoliosis or you want to evaluate the status of their scoliosis.

However, 2016 will delete those three codes and introduce the following instead:

• 72081—Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view
• 72082—…2 or 3 views
• 72083—…4 or 5 views
• 72084—…minimum of 6 views

Although your pediatrician may not be performing these services, she most likely orders them from time to time, so familiarize yourself with the new coding options to ensure that your office requests the appropriate study.