Ear Canal Debridement…Again

Question:

What CPT code would I use for a debridement of purulent debris from the ear canal, with or without placement of a wick in, such as when the patient has Swimmer’s ear? One of my colleagues told me he bills cerumen removal (69210) because there is always a little bit of cerumen mixed in the debris. I thought I’d better check on that.

Answer:

Good idea to check! CPT 69210 (Removal impacted cerumen requiring instrumentation, unilateral) requires the cerumen be impacted and the diagnosis should be 380.4 (Impacted cerumen). If the diagnosis is really Swimmer’s ear and there is “a little bit” of cerumen, then it doesn’t seem right to use 69210 with a diagnosis of 380.4. There is not a CPT code for ear canal debridement for Swimmer’s ear. This service is considered part of the E&M code you will report for that visit. However, if you used the microscope for the diagnosis and treatment then you could also report 92504 (Binocular microscopy (separate diagnostic procedure)).

*This response is based on the best information available as of 01/22/15.

Epidermal Cyst

Question:

Hello, I was at an ASPS coding conference last year and loved what Kim Pollock had to say! She did a great job and was very informative, I learned a lot from her that weekend.

I have a question and was hoping you could give me some insight on it. When coding for a lesion/mass excision removal I know that you code by the size and the location of the lesion/mass but when it comes to depth I am a little confused. The patient has a ruptured epidermal cyst (per the pathology report) removed from the eyebrow/eyelid area and the doctor goes down to and included the oculi muscle to excise it. Would I code from the integumentary system (114xx) or from the musculoskeletal system (e.g., 21012-21014). I am leaning toward the excision of skin (integumentary) codes because the origin of the cyst is from the dermis or epidermis and you would code those from the integumentary system….at least that’s what I heard Kim say at the conference. But because the excision was down to and included the oculi muscle I want to make sure that I wouldn’t code it the musculoskeletal system codes.

Thanks for any help you can provide!

Answer:

Thank you for your kind words – I very much appreciate it! You’re right – you’d use the integumentary system code (114xx) in this situation because the epidermal cyst is of cutaneous origin. The codes in the musculoskeletal system (2xxxx) are for tumors that are non-cutaneous in origin such as lipomas. The depth of the excision, while it clearly makes the procedure more difficult, does not have a bearing on the code. It’s the origin of the lesion/tumor that drives the code choice.

*This response is based on the best information available as of 01/22/15.

Diagnostic Arthroscopy and Meniscectomy

Question:

Can I report a right meniscectomy and left diagnostic knee arthroscopy during the same session?

Answer:

Yes, CPT code 29881 (meniscectomy) and CPT code 29870 (diagnostic arthroscopy) are reportable during the same operative session when they are independently performed on different knees. Use of modifiers may be payor dependent. According to CPT rules, you would report 29881 and 29870-59. Some payors may want the RT/LT modifiers alone; some payors may want the RT/LT and the 59. In 2015, the “X” modifier for separate structure might be required.

*This response is based on the best information available as of 01/08/15.

Removal of JP Drain

Question:

I see my breast reconstruction patients anywhere from a week to ten days postop to remove the drains. Can I bill for this?

Answer:

No. This is part of the routine post-op care included in your payment for the surgical procedure and not separately billable.

*This response is based on the best information available as of 01/08/15.

Suture Removal

Question:

I did not operate on this patient but he ended up in my office for suture removal. Isn’t there a code I can bill for removing sutures when placed by another physician?

Answer:

There is indeed a code for removal of sutures, but only if you do it in under “anesthesia other than local” (CPT 15851, Removal of sutures under anesthesia (other than local), other surgeon). If you are removing the sutures under local or no anesthesia, then the service is included in your E&M code.

*This response is based on the best information available as of 10/16/14.