The following otolaryngology medical coding and billing case samples help you in getting cleaner claims.

Use HCPCS Code for Cerumen Removal Prior to Test

Question: You've lost an appeal on CPT 69210 being billed on the same day as 92567. You're told "the rationale for upholding the denial is: CPT code 69210 is incidental to CPT code 92567 and this code is not separately reimbursed per the ERM, CMS and Encoder Pro. In addition, modifiers are not allowed."

Answer: There's a distinct HCPCS code just for this situation. When your physician does away with impacted earwax so your audiologist can carry out diagnostics, you report G0268 (Removal of impacted cerumen [one or both ears] by physician on same date of service as audiologic function testing).

That's assuming that your physician is getting rid of the earwax separate from the audiologist testing. Medicare will not pay for an audiologist to remove ear wax; CPT 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) is a surgical code. Medicare's policy maintains that audiologists may only carry out diagnostic procedures, such as 92567 (Tympanometry [impedance testing]), never therapeutic (let alone surgical) procedures.

The Correct Coding Initiative bundles CPT 69210 to many audiological test codes (92552, 92553, 92555, 92556, 92567, 92568, and 92586, for example). Though, G0268 is not bundled with audiology services.

Take care: Code 69210 does not define "simple" impaction for instance one that might be addressed through irrigation. In case your physician or a medical assistant can flush the ear out to lessen the patient's symptoms, an impaction really never existed. In case the earwax is effortlessly removed, even with instruments, the procedure does not qualify for 69210. You must link 380.4 (Impacted cerumen) to 69210 to support medical necessity.

To qualify for CPT 69210 , the procedure must necessitate "substantial physician effort and require instrumentation" to eliminate the impacted cerumen, according to Medicare.

Ensure Pathologist Renders 'Uncertain' Dx

Question: What is the dissimilarity between coding a neoplasm of unspecified morphology and one of uncertain behavior?

Answer: Only a pathologist can render a diagnosis of uncertain behavior, for example 238.0 (Neoplasm of uncertain behavior of other and unspecified sites and tissues; bone and articular cartilage). "Uncertain behavior" means the pathologist cannot fully decide the morphology of the cancer. In a physician practice, in case you are uncertain as to what a lesion is as you're waiting for lab results, use an "unspecified" medical coding and billing diagnosis, for instance 239.2 (Neoplasm of unspecified nature; bone, soft tissue, and skin).