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Ear Lobe Reconstruction

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4,466
Location
Milwaukee WI
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0
Okay, we have not done this yet, but just had a young patient come in requesting help.

About a year ago he decided to "gauge up" ... that is, he has large plugs in his earlobes (approx 3 cm in diameter). Now that he's achieved this look he's discovered that he can't get a decent job (or, apparently, find a girlfriend) and he wants his earlobes repaired "like new."

He's been instructed to remove the plugs and let the tissues shrink somewhat over the next six months, and then we'll be attempting to repair.

However ... this is a first in this office.
What diagnosis code? Open wound? Doesn't somehow feel right given that this is a self-inflicted "cosmetic mutilation" (the words of one of our plastic surgeons).

The earlobes are NOT torn ... just have these huge holes in from being "gauged up" (i.e. stretched over time to accommodate the large plugs).

We expect this will be considered strictly cosmetic by insurance carriers.

What procedure code do we use? What kind of fee should we be looking at? The surgeons are thinking that this will be more involved than otoplasty; will take longer, and may even require some sort of "re-do" a year later for better cosmetic effect.

Would really welcome your thoughts and suggestions.

F Tessa Bartels, CPC, CEMC
 
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ASC CODER

True Blue
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571
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0
my first thought would be to use 69399 380.30 or 380.89 v50.1
I would base my fee on the closest procedure to what is being done. Alot of times the fee is based on OR time that has been established by the facility for cosmetic.... for the docs ?? closest matched procedure...
good luck
 
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coderguy1939

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643
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I can't believe this--I got one of these for the first time today, too. Haven't begun yet to tackle this one, but had to let you know you're not alone.
 

Susan

Expert
Messages
463
Location
Glendale
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0
I have these at least a few times a year. As far as coding is concerned the dx code we may use is 380.32 or V50.1. For the CPT code I will use an intermediate or complex closure code or have one "made up" specifically for the repair of the ear lobe. We will not bill the insurance company for this procedure and will include in our pricing the re-piercing for the women who desire to have their ears re-pierced.
 

coderguy1939

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I'm with you on the 380.32 but I don't understand what you mean by "have one "made up" specifically for the repair of the earlobe". By that do you mean an unlisted code? Thanks.
 

Susan

Expert
Messages
463
Location
Glendale
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0
Because there is no "code" specifically for the repair of the ear lobe you can use either the 12051 or 13151 depending on size. Again this repair is most likely not going to be submitted to the insurance carrier and is considered cosmetic in most cases.

What I meant by "making up your own code", my office might use a 99999 for services provided that will not be submitted to the carriers as opposed to using the unlisted code. That way we can easily track procedures that fall under the cosmetic catagory.

I hope that helps.
 
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