Primary Care Coding Alert

Question: A patient came into our office with complaints of ear pain and Herpes simplex. The physician who saw the patient billed 99213 (office or other outpatient visit; established patient). As a result of his examination of the affected ear, the doctor asked the MA to remove excessive ear wax (69210, removal impacted cerumen [separate procedure], one or both ears; with a diagnostic code of 380.4 [impacted cerumen]). Is the physician allowed to bill for the removal of impacted cerumen if it was done by the MA or by a registered nurse?

Helen Grubb
Providence Hospital & Medical Center, Novi, Mich.

Answer: Yes, this is appropriate. The physician can bill for the services of ancillary staff such as medical assistants (MAs), registered nurses (RNs), etc., as if the physician performed the service. But guidelines require that the physician is immediately available to provide assistance if necessary, and that the service provided is within the scope of practice of the healthcare providers (i.e., MA or RN) license or certification.

Coders also should note that, if a medical student or resident performs the procedure, the attending faculty member must be present the entire time if the duration is less than five minutes. If it is a longer and more complex procedure, the attending physician must be present for the most crucial portions of the service.