Swimmer’s Ear

Question:

I am new to ENT coding and am not certain what code I should use. The physician placed an oto-wick in the left ear using the microscope on a patient with swimmer’s ear. Do I just report the microscope code 69990 or do I use a different CPT code?

Answer:

There is no specific CPT code for ear wick insertion. Ear wick insertion is considered a component of the evaluation and management (E/M) service. If the physician uses the microscope you may report CPT 92504 (Binocular microscopy) in addition to the E/M service.

*This response is based on the best information available as of 1/16/25.

Modifier 80 vs 82

Question:

What is the difference between modifier 80 and modifier 82 when a physician is acting as an assistant during surgery?

Answer:

While both modifier 80 and modifier 82 are used when a physician is actively participating as an assistant to a primary surgeon during a surgical procedure, modifier 82 is used in teaching or university hospitals that have approved Graduate Medical Education (GME) programs for Residents. In these teaching hospitals, there must be documentation indicating that no qualified resident was available to assist, to allow for another physician to act as the assistant surgeon, and then modifier 82 is appended to that assistant surgeon.

*This response is based on the best information available as of 1/2/25.

Ear Hairs

Question:

If a patient comes in with ear pain due to loose ear hairs in the ear and the provider removes the hairs with alligator forceps, can it be billed as a foreign body removal?

Answer:

Ear hair(s) are not considered foreign bodies as they are a natural protectant to the inner ear and function to work with earwax to keep the canal clean and debris away from the eardrum.

As such, even though the hair is loose or dislodged, there is not a reportable CPT code for this. The work for removing the hairs is Included in the work for the E/M service, assuming there was a medical necessity for an E/M service (e.g., evaluation of ear pain).

*This response is based on the best information available as of 12/19/24.

“Incident-to” vs “Direct” Billing

Question:

Our nurse practitioner saw a new patient (Medicare) in the office to evaluate sinus complaints. The nurse practitioner developed the plan of care. The patient was scheduled to follow up with the Nurse Practitioner. The patient returned to the nurse practitioner for a return visit with the same problem, and there were no changes in the plan of care. Can the NP bill this “Incident to” the physician since it is an established patient with an established plan of care and the physician was in the office?

Answer:

This is a great question. While the second visit is for an established patient with no change in the care plan, the nurse practitioner must still bill it as “direct.” To move this to an “Incident-to” encounter, there must be an independent encounter with the physician develops the plan of care.

*This response is based on the best information available as of 12/5/24.

ENT Modifier 25

Question:

Does the following scenario meet the modifier 25, “significant, separate service” rules? 

The patient presents with watery eyes, sinus, nasal congestion, and drainage.   The physician evaluates the patient and does a nasal endoscopy to evaluate the upper airway further.   The physician diagnoses the patient as having acute sinusitis and writes a prescription for an antibiotic.  Instructions are given on taking the medications and following up if the patient has seen no improvement after 72 hours.   

May we report an E&M-25 and the nasal endoscopy?

Answer:

Yes, the scenario you present meets the definition of modifier 25. The E&M was not performed for the purpose of the nasal endoscopy, and the physician had additional decision-making related to the management of the sinusitis.

*This response is based on the best information available as of 11/14/24.

ENT Modifier 24

Question:

Q: My physician saw a patient three weeks post-op after an adenoidectomy. The patient is complaining of ear pain at this visit. Can I report am E/M service with Modifier 24?

Answer:

According to CPT and Medicare payment rules, an unrelated problem evaluated and managed during the global period is reportable. The unrelated diagnosis is the “key” to reporting the E&M service during the global period. Modifier 24 must be linked to identify the E&M as unrelated to the surgical procedure during the global period.

Verify that there is not a payor-specific rule, for example, that assigns different global days, e.g., 30 days versus 10 days, to the procedure. Appeal all inappropriate denials. Track the pattern of denials by payor to determine if the trend is payor-specific.

*This response is based on the best information available as of 10/31/24.