Coding Consult

June 17, 2005

Cerumen removal; cyst removal; ECG codes

Cerumen removal Q. I flushed a patient's ears to remove wax. Can I submit 69210 in addition to an E&M code?

For instance, if you used an operating microscope and forceps to remove impacted cerumen, you should assign 69210. Link 380.4 (impacted cerumen) to 69210 to show medical necessity. Payers vary on their guidelines regarding acceptable methods for removing impacted cerumen, so check with your carrier for specific requirements.

You can use 69210 and bill for an E&M service only if you can document that you saw the patient for a reason other than cerumen removal. Attach modifier –25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E&M code.

Cyst removal Q. I excised two sebaceous cysts from my patient's back. One cyst was 4.7 cm and the other was 3.3 cm. How should I code this?

A. For the 4.7 cm cyst excision, you should assign 11406 (excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over 4.0 cm). For the removal of the 3.3 cm cyst, you should report 11404-59 (. . . excised diameter 3.1. to 4.0 cm; distinct procedural service). You need to attach modifier –59 to 11404 to show the insurer that the second excision was separate and distinct from the first procedure.

ECG codes Q. Which modifiers should I use when billing 93000 to Medicare? I tried both the technical and professional component modifiers without luck.

A. An electrocardiogram's technical and professional components have their own CPT codes, so you don't need modifiers to report them. Remember that 93000 (electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) represents both the ECG's technical and professional components. Meanwhile, 93005 (. . . tracing only, without interpretation and report) represents only the technical component, and 93010 (. . . interpretation and report only) represents only the professional component.

If you performed the technical portion of the ECG (tracing) as well as the professional portion of the ECG (interpretation and report), you would report 93000.

If the technical portion (tracing) was done somewhere other than your office, but you did the interpretation and report, you would use code 93010.

Finally, if you provided the tracing only but an outside physician provided the interpretation and report, you would report 93005.

This information adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples FL 34112; phone 800-508-2582; fax 800-508-2592 or visit