# 69209



## TLC (Jan 12, 2016)

Can this be billed under the doctor if a medical assistant is doing the procedure? Our MA's do a lot of the ear lavages. We stopped billing 69210 for them since it had to be done with "instruments". We would just bill a 99211 for them. Thanks


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## ehanna (Jan 12, 2016)

TLC said:


> Can this be billed under the doctor if a medical assistant is doing the procedure? Our MA's do a lot of the ear lavages. We stopped billing 69210 for them since it had to be done with "instruments". We would just bill a 99211 for them. Thanks




Yes you can


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## TLC (Jan 12, 2016)

Thank you


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## susie09 (Jan 20, 2016)

Are orders needed from the Physician if a MA is doing the services or can the patient just come in and have it done?


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## CodingKing (Jan 20, 2016)

susie09 said:


> Are orders needed from the Physician if a MA is doing the services or can the patient just come in and have it done?



It must be ordered by the physician. An MA cant just start initiating procedures


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## susie09 (Jan 20, 2016)

thats what I thought, thank you


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## JulieKasik (Jan 27, 2016)

ehanna said:


> Yes you can



Do you have the source from where you obtained this information? I haven't seen anything in the CPT book, or from CMS or any of the associations confirming this yet.  I want to make sure I have a source prior to communicating this with my providers.


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## mitchellde (Jan 27, 2016)

It is stated in the CPT changes book for 2016


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## JulieKasik (Jan 27, 2016)

mitchellde said:


> It is stated in the CPT changes book for 2016



I am looking at the book and it says nothing about MA's.


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## JulieKasik (Jan 27, 2016)

it says qualified professionals.. and according to the CMS Part B article, it only covers RN's. 

Part B News
Year:	2015
Issue:	December 21
Title:	New cerumen impaction removal code could add extra payment, confusion

Expect to see a Correct Coding Initiative (CCI) edit for 69209 when billed at the same time as an E/M service — an edit exists for 69210 and an E/M service.
Because the impacted cerumen removal using lavage or irrigation is typically done by a nurse, practices may see the code as a way to get paid extra for the cerumen removal because it likely wouldn’t impact the level of a medically necessary E/M service, Lewis believes.
As an example, she cites a patient who presents to the office with ear pain. The physician would do the full workup for the problem-focused visit, and one element of the medical decision-making would be to discover and remove the impacted cerumen.
If instrumentation is not needed, then the cerumen removal would be done by the nurse, and the practice would bill 69209. 


https://www.encoderpro.com/epro/coderEssential3PackContentOnlyHandler.do?_k=3039*521149&_a=view


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## mitchellde (Jan 27, 2016)

Look under rationale second paragraph.  It states performed or supervised by physician or qualified non physician practitioner.  The physician or NPP must be on site.  Then in the clinical example it states the physician gives the order fir the nurse to irrigate the ear.


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## JulieKasik (Jan 27, 2016)

mitchellde said:


> Look under rationale second paragraph.  It states performed or supervised by physician or qualified non physician practitioner.  The physician or NPP must be on site.  Then in the clinical example it states the physician gives the order fir the nurse to irrigate the ear.



Correct, again it says Nurse or NPP. And  Non Physician Practitioner is NOT an MA. A  qualified nonphysician practitioner is a nurse practitioner, physician assistant or
clinical nurse specialist.


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## mitchellde (Jan 27, 2016)

It says supervised by physician or NPP.  As long as the other ancillary person is employed by the physician and is qualified to perform the task, they fall into the same category as an RN.  RNs and MAs and LPNs all fall into the category of "other qualified ancillary staff".  They are not NPPs.  So as long as it is performed by a qualified staff person and an NPP or physician is supervising then yes.


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