Everyone’s favorite office procedure, cerumen removal using lavage (69209) made a cameo appearance during the E/M office visit coding presentation during the AMA’s virtual CPT RBRVS Symposium this week.
Speakers Peter Hollmann M.D. and Barbara Levy M.D. used the scenario to illustrate the important point that when an E/M service is reported at the same encounter as an office procedure, the two services can’t have overlapping time.
Here’s the case description:
“A 47-year-old Laotian-speaking male returns to the office with a new complaint of unilateral hearing loss. History obtained through the translator reveals that he had cold symptoms last week which seemed to resolve, but then he lost hearing in his left ear. It is not complete, but sounds are diminished. He has no other complaints. HEENT exam is negative except for wax in the left ear canal. It is cleared with irrigation. Upon clearing, the TM appears normal and the patient reports his hearing is also restored. Because of the need for translation services and the removal of wax, the encounter takes 21 minutes.” [emphasis original]
The physician reports an office visit with modifier 25 and code 69209 for removal by irrigation of the impacted cerumen.
Levy and Hollmann code the visit using MDM as a level 2 established patient visit (99212), noting that the patient had one acute, uncomplicated illness or injury, so the number and complexity of problems addressed was low. In addition, no data was reviewed, for a straightforward-level data reviewed score, and there was minimal risk of morbidity from additional diagnostic testing or treatment.
But wait – can’t you report it based on time? If it took 21 minutes, wouldn’t it be a level 3 (99213) visit?
Not unless you can support that you performed the cerumen removal in less than two minutes, says Hollmann. “In this case, the E/M time must be independent of any time related to a separately reported service,” he explains.
Though E/M office visit codes “are not truly ‘time based,’ when code selection is based on time, they become so," Hollmann observes. That means they come under the CPT rules for time-based codes, which state:
“When another service is performed concurrently with a time-based service, the time associated with the concurrent service should not be included in the time used for reporting the time-based service.”
The time range for 99213 is 20-29 minutes, so in order to report that code, you would have to support that you did a super-speedy cerumen irrigation procedure.