# Cerumen Removal with E&M



## cgneff72 (Jun 12, 2012)

Recently, all of our claims for cerumen removal (69210) are being denied by one of our Medicaid plans with the following:
    "The procedure code 69210 is designated as a separate procedure and should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.  The complicating factor with this procedure is the fact that many times removal of impacted cerumen is required in order to visualize the ear canal and assess the patient's condition.  In these cases, it is considered part of the primary service and not separately reimbursed."

While I understand what they are trying to say, am I to assume that the only time it would be payable is if it is the only service on the claim??

We added modifier 25 to the E&M, but they are not paying on 69210 at all.  Has anyone else experienced this?


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## mitchellde (Jun 12, 2012)

You will have to appeal with notes showing the provider performed this using a scoop or currette, not an irrigation, and it was therapeutic not for better visualization.


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## cgneff72 (Jun 13, 2012)

We have done that already.  The appeals were all denied with the reasoning I entered in the first post.


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## mitchellde (Jun 13, 2012)

If it was in fact for better visualization then it is included in the E&M, but it is not always that it has to be a stand alone procedure.  If it is for therapeutic benefit to the patient and documentation can support that it can be billed with an office visit and both can be paid.  Without looking at your documentation I cannot advise.


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## ksd (Jun 13, 2012)

I code ER and Urgent Care charts for varying physicians in multiple states and regardless of the method or reasoning for cerumen removal Medicaid never pays.  This is just my experience.


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## hopepg (Jun 14, 2012)

I used to bill for a peds ofc in OK. OK Medicaid doesn't cover it with an E/M either.


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