# Nurse visit for cerumen removal



## kamkole (Jan 29, 2008)

Would it be appropriate to bill a nurse visit 99211 for cerumen removal?  We are also provider based and I've heard there are new guidelines for Incident To billing in this setting.  

Thank you!


----------



## kbarron (Feb 2, 2008)

*Cerumen removal*

My understanding is that "a physician skill " is required to remove cerumen. If a lavage is done, a nurse can do it but may not charge. Any other takers on this one?


----------



## member7 (Feb 2, 2008)

Karen I agree with you. But I read through the Medicare Claims Processing Manual section 30.6.4 and it would seem that if the office visit with the lavage was billed as incident to, meaning that the physician provided direct supervision, then 99211 can be billed under the physician's or NPPs number.  Did I misunderstand?  The Medicare carriers I've look through do say that 69210 can only be done using the skills of a physician. Any other thoughts?


----------



## rthames052006 (Feb 2, 2008)

member7 said:


> Karen I agree with you. But I read through the Medicare Claims Processing Manual section 30.6.4 and it would seem that if the office visit with the lavage was billed as incident to, meaning that the physician provided direct supervision, then 99211 can be billed under the physician's or NPPs number.  Did I misunderstand?  The Medicare carriers I've look through do say that 69210 can only be done using the skills of a physician. Any other thoughts?



This is what our office does also, we only bill the 69210 when the physician does the service, we actually have a few physicians that love doing it.

Roxanne Thames, CPC


----------



## Tmamma (Feb 2, 2008)

I am new to coding but I've been told that a nurse usually performs the lavage but if a cerumen tool is used then the  physician would get the credit provided there was documentation as to what procedure was performed and who performed it. Is there documentation to say who performed the cerumen removal? Nurses notes or physican notes?


----------



## kbarron (Feb 3, 2008)

*Cerumen removal*

I actually wonder how many MD's stay in the room as the nurse removes the cerumen by lavage.....I have heard say that direct supervision means the the MD is in the suite. I tend to disagree, as in my mind direct supervision is the Doc is standing there in the room...


----------



## rthames052006 (Feb 3, 2008)

kbarron said:


> I actually wonder how many MD's stay in the room as the nurse removes the cerumen by lavage.....I have heard say that direct supervision means the the MD is in the suite. I tend to disagree, as in my mind direct supervision is the Doc is standing there in the room...



I guess everyone is a little leary of certain things.  When our Pa's see pts  there is always another physician in the office, we are a large Internal Med practice ( 25 providers ) so usually we only have 1 Pa in the office with 6-8 MD's there are times when the doc does have to go in the room with the Pa , depending on the situation, but not always, we don't bill alot of Incident to.  Only if the doc has to go in the room to help with something and then the doc makes  a note on the charge slip so we know to bill it as incident to.


Your right about your though of how many MD's stay in the room w/ the nurse I know none of our doc's do, but then again there are some of our docs who do their own ear cleanings.

Roxanne Thames, CPC


----------



## mhadsell (Feb 18, 2008)

A medical assistant may do an ear lavage only.  (S)he may not insert a tool such as a loop into the ear cavity to extract cerumen.  Only a medical provider may do that.  So only a medical provider may bill for a 69210.  If a medical assistant simply flushes the ear, that is coded with a 99211.


----------

