Wiki New patient and procedure on the same day.

[bmanus]

Good Afternoon

If a new patient presents to our office for ear pain while chewing. The doctor completes all the elements required for a 99203 and also a 69220. The findings are debris in the mastoid cavity and TMJ. Patient is being referred out for the TMJ.

Can the E/M be billed along with the procedure?

Per NCCI guidelines the new patient E/M would be included in the procedure.

Thank you,

Beth

 

[MarcusM]

CPT 69220 in the AAPC shows: "Debridement, mastoidectomy cavity, simple (eg, routine cleaning)" with "The physician performs post operative removal of contaminated tissue from the mastoid cavity. The cavity and the auditory canal are then irrigated with normal saline, antibiotic drops instilled in the bony cavity, and dressing applied."

Elsewhere I find:
69220 - Under direct visualization, the physician uses suction, a cerumen spoon, and delicate forceps to remove skin debris and drainage from the mastoid cavity, a bony extension of the ear canal. The cavity is cleaned simply in 69220. The cavity may require more extensive cleaning, as in the case of infection or extensive debris, in 69222. Routine mastoid cavity debridement is required every three to six months in patients who have undergone a radical or modified radical mastoidectomy."

 

[bmanus]

Thank you Marcus.

The questions is can the new patient office visit me billed as well?

 

[AprilSueMadison]

There has to be something significant and separate from the procedure to bill an office visit, even if the patient is a new patient.

If that is determined to be the case, use a -25 on the E&M code.

Unfortunately, based on the information it's hard to make a decision if anything should be billed with the procedure.

 

[MarcusM]

I should have explained my answer in more detail. Did your doctor actually perform CPT 69220? Or was it more in line with an ear lavage? If an ear lavage, then this is included in the E&M code and you would not bill CPT 69220. If the documentation supports the 69220, and a new patient E&M, then bill both with the 25 modifier on the new patient CPT and expect the carrier to request the records for their audit.