Wiki EarWell System (use 21086??)

[ltaylorcpc]

I have a sales rep with a product (called EarWell) advising me to use 21086. I don't get a warm fuzzy feeling using this code because of the wording in the CPT book, "...physician actually designs and prepares the prosthesis...". We are getting this product from the sales rep. If you go to the website there is a short video www.beconmedical.com/earwell that would help with the visual. I just spoke with a certified coder who bills this code and states "this is not a one size fits all" and "it (EarWell) has to be shaped and incorporated to each ear". Does anyone have a few minutes to look into this and give me their two cents worth.
Thanks much,
Lila L Taylor CPC, COBGC

 

[jackjones62]

Unless your physician actually designs and prepares a prosthesis (ie, not prepared by an outside lab), you cannot bill 21086; also, I do not believe this item can be referred to as a "prosthesis" as it is not an artificial substitute or replacement of the ear. It obviously is an interesting corrective technique, but also understand that a vast majority of insurance companies will consider this a type of cosmetic intervention; we perform many otoplasties for external ear deformities and most patient pay out-of-pocket; unless the deformity somehow causes hearing impairment or some type physical pain or suffering and we can prove medical necessity it is not a covered procedure; so, with that said, this corrective device seems to fall into the same category as being "cosmetic"; you are right to be wary of their sales pitch.

Jennifer
CT ENT