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ENT Fitting Question

BABS37

Expert
Messages
311
Location
Des Moines
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We are having a little debate on billing out 21086 for ear well devices... does anyone have any information on this? Does this look like 21086 even if the physician doesn't say he did a mold/cast? So confused... If they can't bill 21086- what is the appropriate code for the below surgery as this is how all of them have looked... :confused:

Procedure: Impression and custom preparation: Surgical obturator prosthesis, auricle, Bilateral


Indications: Bilateral auricular deformity with Pixie deformity. Abnormal curvature to the helical fold with flattening of apex and abnormality of conchal bowl

With the family's permission we proceeded with the procedure today.

First the left ear was prepped in a standard fashion with shaving of the repair surrounding the auricle allowing for the site of contact of the cradle. Once repair was removed and the skin was prepped with alcohol and Mastisol.

The left medium-sized cradle was then applied to the lateral mastoid and periauricular tissues after the removal of the tape over the adhesive. The auricle was delivered into the cradle and the anterior portion was placed first anterior to the tragus. The posterior portion was placed behind the auricle in the postauricular space. We were sure to stay 2 mm beyond the cartilage of the conchal bowl posteriorly.

The medium-sizeformer was applied. . It was placed superiorly so as to unfold the auricle and flatten and the Pixie deformity to the appropriate curvature of the superior portion of the auricle. This was placed down to the cradle and the adhesive of the cradle held the former in place. The placement of the first former was sufficient. The helical fold was created and the flattened portion was curled appropriately without any difficulty. There was no blanching of the surrounding skin. A conchal bowl former was placed as well to compress the bowl The cover of the device was placed securely. We inspected the skin within the device which is transparent. There is no evidence of any blanching of the skin. The irregular shape was appropriate.

The right ear was prepped in a standard fashion with shaving of the repair surrounding the auricle allowing for the site of contact of the cradle. Once repair was removed and the skin was prepped with alcohol and Mastisol.
The right medium-sized cradle was then applied to the lateral mastoid and periauricular tissues after the removal of the tape over the adhesive. The auricle was delivered into the cradle and the anterior portion was placed first anterior to the tragus. The posterior portion was placed behind the auricle in the postauricular space. We were sure to stay 2 mm beyond the cartilage of the conchal bowl posteriorly.

The medium sized former was used for the right ear. The smaller was unable to produce the appropriate fold of the helical tissue. We used the device to curl the auricular cartilage and to compress the cartilage in between the helical an antihelical fold into the appropriate concave orientation. This was secured to the adhesive of the remainder of the cradle. We felt that we had appropriate positioning of the auricular cartilage. There was no blanching of the tissues. The conchal bowl former was placed at this time. The cover was then applied and the skin was inspected through the transparent device to find that there was no blanching of the skin.

At this point the procedure was terminated.
 

BABS37

Expert
Messages
311
Location
Des Moines
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I understand 21086 but my physicians believe that 21086 is appropriate for what they are documenting below and have received confirmation from an ENT source- that I don't know where it came from because I can't find anything. I have read that it depends on the insurance carrier if they are responsible to pay these or if they should be considered patient responsibility- Iowa. I don't want to argue with them so I am hoping someone has ran into this problem and has supporting documentation or suggestions for this... :( or maybe a more appropriate code to bill? My other thought is maybe the physicians are making these but jsut not documenting them and then billing out 21086 as the end state fitting? I don't know.
 

kcap2210

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ear well

We are still fighting this issue today, four years after this thread started. Everyone has their interpretation of what this code means. The high RVU's and fact that it clearly states a prosthesis is made makes me believe this is not an appropriate code.
 
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