Medicare Compliance & Reimbursement

One practice challenged Medicare and won for its G0268 claims If you've got one New Year's resolution this year for your practice, perhaps it should be to stop waiting and to start filing appeals for the services that you know payers incorrectly denied. One practice says that billing audiology evaluations with cerumen removal is more than meets the eye, and that it was able to collect for the procedure by investigating the right codes and filing appeals. Although CPT lists 69210 (Removal impacted cerumen) as the correct cerumen removal code, you have to look further if you're billing Medicare for this service on the same date as a comprehensive audiometry threshold evaluation (92557). "Medicare won't pay for an audiologist to remove cerumen," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions. "Therefore, Medicare carriers require you to report G0268 (Removal of impacted cerumen by physician) with 92557. This tells the payer that the physician -- and not the audiologist -- performed the cerumen removal." Example: The physician performs cerumen removal in the exam room, and the audiologist performs a comprehensive audiometry evaluation in the audio booth. The practice should report 92557 and G0268 to the Medicare payer. Problem: In some instances, insurers will deny the cerumen removal charge even if you bill it correctly using G0268, says Dawn Bridges, CPAR, CPC, of Northside Ear, Nose and Throat in Roswell, GA. "Maybe the insurer is denying it because it feels that the wax was hindering a proper audio exam, therefore it needed to be removed to obtain an adequate audio test," she suggests. In that case, the insurer probably will not reimburse for the cerumen removal. Solution: "I have had this happen to me before, and upon review of the documentation, some were necessary to remove for audio testing and some were separate procedures. I appealed the ones that were separate with good results," Bridges says.