Medicare Compliance & Reimbursement

In a story in Medicare Compliance & Regulation Vol. 34, No. 4 ("Forget G Code For Cerumen Removal And Forget Payment"), we offered several tips about how to collect for audiology with cerumen removal. The strategy has paid off for one satisfied billing director who fought her insurer and won.

Laura Colbert Carbonaro, central billing operations director at ENT and Allergy Associates LLP, was tired of having her staff spend time appealing denials for G0268 (Removal of impacted cerumen by physician) with 92557 (Comprehensive audiometry threshold evaluation) to one carrier. "I knew that on a global level the policy to deny these services should be changed," she says. She requested a national policy review and was informed that Cigna would announce in its next Claim Check Update in July that it will start to reimburse these codes together.

"More and more insurance companies beyond Medicare are recognizing G0268. So when that code applies and a practice is seeing denials, they should try using the G code on a few test claims," Carbonaro says. "If the carrier claims to follow Medicare guidelines, then showing Medicare's position will generally assist in getting a claim denial policy changed globally so the individual claims no longer need to be appealed."