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Otolaryngology Coding Alert

Stick With E/M for Ear Wick Placement -- But Don't Miss Visualization Charge

AAO-HNS confirms -traditional- service coding for this procedure Although alternative surgical CPT codes may tempt you when coding for your otolaryngologist placing an ear wick, the tried and true is the way to go.
Problem: -There is no specific code for placing an ear wick,- says Robert W. White, practice administrator at Eastern ENT Sinus and Allergy Center PA in Goldsboro, N.C. Payment depends on the insurer, he adds. Understand the Procedure Before trying to code ear wick placement, get a grip on what the procedure involves. The otolaryngologist places an ear wick as a surgical procedure to treat conditions such as otitis externa (380.12, Acute swimmers- ear) and diffuse acute otitis externa (380.10, Infective otitis externa, unspecified). It is not a diagnostic procedure, White says.

The physician applies liquid medication to a sterile, compressed sponge, which gently and evenly expands to fill the ear canal, dispersing the medication and applying gentle pressure to the tissue. He inserts the sponge gently, usually under direct visualization, taking care not to push it in too deep. Ditch These 2 Methods Some coders may propose the erroneous idea that you could use 69200 (Removal foreign body from external auditory canal; without general anesthesia) for ear wick placement. The false rationale: An ear wick is a foreign body, which makes 69200 similar, except the code describes removal, rather than placement.

Problem: CPT warns against using codes that -approximate- services or procedures. Code 69200 is inappropriate for placement because one is using a -like- code, says Michael Setzen, MD, FACS, FAAP, chief of rhinology at North Shore Otolaryngology Associates in Manhasset, N.Y.

Instead of using an approximate code, some coders incorrectly suggest reporting the placement with the external ear unlisted-procedure code 69399 (Unlisted procedure, external ear). The false reason purports that because the procedure is surgical and involves the external ear -- but CPT doesn't contain a specific code for the procedure -- the code for an external ear surgical procedure is appropriate.

You should instead reserve the unlisted-procedure code for novel procedures, says Hayes H. Wanamaker, MD, chief of otolaryngology at Crouse Hospital in Syracuse, N.Y. -The RVU comparable value and expected reimbursement would be so low that it wouldn't be worth the hassle of providing the documentation and fighting for reimbursement,- he adds. Include the Placement in the E/M Service Traditionally, otolaryngologists have leaned toward using 99201-99215 (Office or other outpatient visit) to
represent the work involved in ear wick placement. -I have routinely included insertion and removal of an ear wick as part of the E&M code,- Setzen says.

Official guidance: The American Academy of Otolaryngology -- Head and Neck Surgery (AAO-HNS) confirms that you should include the ear wick placement in the E/M code you report [...]

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