Revenue Cycle Insider

Question: Is it possible to get paid for 92504 and 69210 when the two services are performed at the same encounter?

AAPC Forum Participant

Answer: No, you cannot bill for 92504 (Binocular microscopy (separate diagnostic procedure) and 69210 (Removal impacted cerumen requiring instrumentation, unilateral) when the two services are rendered to the same patient at the same encounter.

Why? Because the microscopy procedure is necessary for inspecting the ear canal and viewing the tympanic membrane prior to removing impacted cerumen, 92504 is regarded as a component of the more comprehensive 69210 service. That is reflected in the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits for 69210, which bundles 92504 into 69210. When 92504 is the column 2 code for 69210, Medicare assigns a modifier indicator of 0 to the pair, meaning that Medicare does not allow you to override the edit with an NCCI-associated modifier, and they will only pay for the column 1 code (69210) when both codes are reported for the same beneficiary on the same date of service.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC