CPT code 69110 – Partial excision of the external ear

Key takeaways

CPT code 69110 covers partial excision of the external ear with simple repair. Complete removal of the ear is coded 69120.

The code carries a 90-day global period, so related post-operative visits are bundled into the surgical package.

Append RT or LT to every 69110 claim, because a missing laterality modifier is one of the most frequent denial triggers.

The operative note must record lesion size, margins, closure technique, and laterality to pass medical necessity review.

Pabau, the practice management platform we build, scrubs each claim for missing or invalid details before it goes out through the Claim.MD clearinghouse.

CPT code 69110: Official descriptor and clinical context

CPT code 69110 describes “Excision external ear; partial, simple repair.” The defining word is partial. The surgeon removes a diseased or abnormal portion of the auricle and preserves the remaining cartilage and skin framework. That separates it from CPT 69120, which covers complete amputation of the external ear.

The code sits within the 69000-69399 range, which the American Medical Association designates as Surgical Procedures on the External Ear. ENT (otolaryngology) practices and plastic surgeons bill it most often. Dermatologists excising malignant or pre-malignant lesions of the pinna also bill it regularly.

The “simple repair” language in the descriptor matters for coding, because 69110 includes a primary closure only. When the defect is closed with an adjacent tissue transfer, the transfer code includes the excision. On the ear that is usually 14060, reported in place of 69110 rather than alongside it.

A skin graft or a complex layered closure is coded separately, so record the repair type explicitly in the operative note.

Quick reference: CPT 69110 at a glance

The table below summarizes the billing parameters coders need before submitting a 69110 claim.

Use the CMS Physician Fee Schedule lookup tool to retrieve the current-year facility and non-facility payment rates for 69110 by locality. Rates change each January 1 and vary by geographic pricing area, so bookmark the lookup rather than relying on a cached figure.

What CPT code 69110 covers: Procedure scope and inclusions

CPT 69110 covers partial removal of any part of the external ear. That includes the auricle (the visible cartilaginous structure), the pinna, and the periauricular skin attached to it. Lesion types within scope include:

• Preauricular cysts and sinuses: Congenital pits or sinus tracts in front of the ear that become infected or symptomatic. They are among the most frequently billed indications for 69110.
• Benign auricle lesions: Keloids, sebaceous cysts, fibromas, chondromas, and lipomas involving the pinna.
• Malignant and pre-malignant lesions: Basal cell carcinoma, squamous cell carcinoma, and actinic keratoses of the external ear skin requiring excision with margins.
• Ear tags and accessory auricles: Congenital remnants arising from abnormal auricular development (Q17.x ICD-10 range).
• Acquired deformities requiring partial resection: Post-traumatic or inflammatory scarring where only a portion of the cartilage is excised.

The key exclusion is complete removal. If the surgeon removes the entire external ear, 69120 applies. The operative note must state that the ear architecture was preserved and the resection was partial.

Procedure steps and documentation requirements

Knowing the operative sequence helps coders confirm that the procedure maps to 69110 and that the note contains the elements payers audit.

1. Patient preparation and anesthesia: Local infiltration is standard for office-based lesion excision. General anesthesia or monitored anesthesia care may apply for pediatric patients or complex resections. Document the anesthesia type.
2. Lesion marking and measurement: The surgeon marks excision margins around the lesion. The pre-operative note or operative report must record lesion dimensions and confirm laterality. An example is “1.2 cm x 0.8 cm sebaceous cyst of the right auricle.”
3. Excision: The surgeon incises through skin, subcutaneous tissue, and cartilage as needed. The specimen is removed en bloc, with appropriate margins for malignant or suspicious lesions.
4. Hemostasis and closure: Electrocautery controls bleeding, then the wound is closed. The “simple repair” in 69110 covers primary closure only, so document any flap or graft separately.
5. Specimen disposition: The operative note should record whether pathology was ordered and confirm the specimen was labeled with laterality.

The pathologist reports the specimen exam on their own claim, often with 88305 for a skin or soft tissue specimen. That exam sits outside the 69110 global package.

The operative note is the payer’s primary audit document. Three omissions most often trigger a medical necessity review or a downcode request. They are missing lesion dimensions, absent laterality, and a vague closure description.

CPT 69110 vs 69120 and other adjacent codes

One clinical fact decides between 69110 and 69120, and that is how much of the ear was removed. The table below maps the distinction and covers other codes coders sometimes pull instead of 69110.

Decision rule: If the operative note states the auricle or pinna was partially resected and the remaining ear was repaired primarily, 69110 is correct. If the note states total removal of the ear, use 69120. When only a tissue sample was taken, 69100 applies instead.

A skin lesion excision with no cartilage involved usually belongs in the 11440 to 11446 range, so check with the surgeon before coding. A benign lesion with a 1.1 to 2.0 cm excised diameter on the ear, for example, is 11442. The chart below runs these questions in the order a coder should ask them.

ICD-10 diagnosis codes that support medical necessity

Every 69110 claim requires a supporting ICD-10-CM diagnosis code that establishes medical necessity. The table below lists the codes payers most commonly accept with 69110, drawn from the CDC/NCHS ICD-10-CM web tool. For a diagnosis outside this list, our ICD-10-CM code library covers the full tabular list.

Caution: Codes in the Q17 and Q18 congenital range often attract cosmetic-exclusion reviews. Document any functional impairment, recurrent infection, or pain associated with the lesion to establish medical necessity beyond the diagnosis code alone.

Medicare and payer reimbursement

Medicare reimbursement for CPT code 69110 is set each year in the Medicare Physician Fee Schedule (MPFS). The Centers for Medicare and Medicaid Services (CMS) administers it. Payment rates differ based on place of service and geographic pricing locality.

Use the FastRVU lookup tool to retrieve current work, practice expense, and malpractice RVU values for 69110 without buying the full AMA data file.

For locality-adjusted dollar amounts, the CMS MPFS search tool is the authoritative source. The 90-day global also shapes the follow-up schedule, because related post-operative visits in that window are not billed separately.

Modifiers that apply to 69110

After incomplete documentation, modifier selection is where 69110 claims fail most often. Each modifier below triggers a specific reimbursement or processing rule.

• RT / LT (right / left ear): Required by Medicare for paired-organ procedures, and omitting laterality is a frequent 69110 denial trigger. Append RT or LT based on the operative note, not the referring diagnosis alone.
• Modifier 50 (bilateral procedure): Use only when both ears are operated on in the same session. Medicare and most commercial payers pay 150% of the single-procedure rate with modifier 50. Some payers want two line items (one with RT, one with LT) instead, so check payer-specific rules before submitting.
• Modifier 51 (multiple procedures): Append to the lower-valued procedure when 69110 is performed alongside another surgical code in the same session. Medicare pays 50% for the secondary procedure.
• Modifier 57 (decision for surgery): Append to the E/M visit that led to the decision to operate. It applies on the day of surgery or the day before. The 90-day global would otherwise bundle it.
• Modifier 58 (staged or related procedure during global period): Use for a planned, staged procedure inside the 90-day global period. A second-stage reconstruction of the auricle after the initial excision is one example.
• Modifier 78 (unplanned return for related procedure): Use for an unplanned return to the operating room for a complication of the original 69110 procedure.
• Modifier 79 (unrelated procedure during global period): Use when a procedure performed within the global period is unrelated to the original 69110 surgery.
• Modifier 52 (reduced services): Use when the surgeon performs less than the full procedure the descriptor describes. A procedure discontinued after anesthesia starts takes modifier 53 instead.

Common billing errors and denial reasons

Each denial below traces back to the record or the claim form, which is where it gets fixed for good. These are the most frequent triggers, based on coding guidance from the AAPC and common payer audit patterns.

• Missing laterality modifier (RT/LT): A common Medicare denial. The operative note must state left or right, and the coder must carry that through to the modifier. Fix: Add RT or LT before submitting, or use modifier 50 if both ears were treated.
• Wrong code selection (69110 vs 69120): The claim uses 69110 for a documented complete removal, or 69120 when only a portion was excised. Fix: Read the note for explicit language about how much ear tissue was removed before assigning the code.
• Cosmetic exclusion denial: Payers deny 69110 for ear tags (Q17.0) and keloids (L91.0) when no symptom documentation accompanies the claim. Fix: Include a clinical note documenting functional impairment, recurrent infection, or pain.
• Wrong modifier on a same-day E/M: Because 69110 has a 90-day global, an E/M visit that leads to the decision to operate takes modifier 57. A significant, separately identifiable problem treated at the same visit takes modifier 25. Fix: Match the modifier to the reason for the visit, or the payer bundles it into the surgery.
• Incomplete operative note: Notes that omit lesion size, margins, laterality, or closure technique fail medical necessity review. Fix: Run the documentation checklist in the next section before the claim is submitted.
• Coding the diagnosis before pathology returns: A claim coded as malignant before the pathology report confirms it invites a records request. Fix: Hold the claim until the report is back, then code the confirmed diagnosis.

How to document the excision to support medical necessity

A denial is cheapest to prevent while the note is still being written. The checklist below maps to the elements payer reviewers check against Local Coverage Determinations (LCDs) on 69110 claims.

• Pre-operative diagnosis with ICD-10 code: The pre-op note must state the diagnosis specifically enough to support the ICD-10 code. An example is “right preauricular sinus, recurrently infected (Q18.1).” A generic “ear lesion” note triggers additional information requests.
• Symptom duration and conservative treatment: For lesions a payer could call cosmetic (ear tags, keloids, minor cysts), document how long the patient has had symptoms. Record what conservative management was tried and why surgical excision was indicated. That chain of reasoning turns a marginal claim into a payable one.
• Lesion dimensions in centimeters: Record length x width, and depth if relevant. Payers use size to confirm the procedure matches the code billed.
• Operative details: State which ear was treated and how much of it was removed (partial or complete). Record how the wound was closed (primary closure, flap, graft) and whether cartilage was involved. Each of these elements maps to a coding decision.
• Pathology linkage: If a specimen was sent for pathology, note the order in the operative record and cross-reference the pathology report when it returns. For malignant lesions, the pathology confirmation strengthens the medical necessity record for the excision.
• Post-operative follow-up plan: State the follow-up interval and whether more procedures are planned. This sets the 90-day global context and settles which modifier applies if a modifier 58 or 79 situation arises.

How claims management software keeps 69110 claims clean

When billing runs in a tool kept apart from the chart, a coder reads the operative note and retypes the code. The modifier gets picked by hand. Each handoff is a chance to drop the RT or LT, or to send a congenital diagnosis with no symptom note.

In Pabau, the operative note and the claim sit on the same patient record. Pabau’s claims management software scrubs every claim for missing or invalid details before it leaves, and flags any that need action. Claims then go out through the Claim.MD clearinghouse to thousands of US payers.

Eligibility checks run before the procedure date, so a coverage problem surfaces while it can still be fixed. Claim status updates and electronic remittance advice (ERA) come back against the same record. For the habits that get a claim paid first time, see our guide to the clean claim.

Fewer 69110 denials, less claim rework

Pabau scrubs each claim for missing or invalid details, checks eligibility before the visit, and posts ERA payments against the patient record. See how it handles surgical claims like 69110.

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Conclusion

A clean 69110 claim is decided in the operative note, well before anyone opens the claim form. The note has to say how much of the ear came off, which side, and how the wound was closed. The code and the modifier follow from those three lines.

The 90-day global is the detail to carry forward from this page. Plan post-operative visits as part of the package. Use modifier 57 when the decision to operate is made that day or the day before, and keep 58, 78 and 79 for what follows.

Pabau sends each claim through the Claim.MD clearinghouse to thousands of US payers, scrubbed before it leaves. Book a demo to see how Pabau keeps ear surgery claims moving from note to payment.

Continue your research

Need to understand how claims reach payers electronically? 837 file format guide explains how electronic claim files are structured and transmitted.

Seeing repeated denials on surgical claims? Denial management in healthcare covers how to build a systematic denial reduction workflow.

Want to verify patient coverage before the procedure date? Insurance eligibility verification explains the real-time check process that prevents post-service cosmetic-exclusion surprises.

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