Otolaryngology Coding Alert

Question: Ive lost an appeal on 69210 being billed on the same day as 92567. Im told the rationale for upholding the denial is: CPT code 69210 is incidental to CPT code 92567 and is not separately reimbursed per the ERM, CMS and Encoder Pro. In addition, modifiers are not allowed.

Rhode Island Subscriber

Answer: Theres a special HCPCS code just for this situation. When your physician removes impacted earwax so your audiologist can perform diagnostics, you report G0268 (Removal of impacted cerumen [one or both ears] by physician on same date of service as audiologic function testing).

Thats assuming that your physician is removing the earwax separate from the audiologist testing. Medicare will not pay for an audiologist to remove ear wax; 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) is a surgical code. Medicares policy states that audiologists may only perform diagnostic procedures, such as 92567 (Tympanometry [impedance testing]), never therapeutic (let alone surgical) procedures.

The Correct Coding Initiative bundles 69210 to many audiological test codes (92552, 92553, 92555, 92556, 92567, 92568, and 92586, for example). However, G0268 is not bundled with audiology services.

Take care: Code 69210 does not describe simple impaction such as one that might be addressed through irrigation. If your physician or a medical assistant can flush the ear out to alleviate the patients symptoms, an impaction really never existed. If the earwax is easily removed, even with instruments, the procedure does not qualify for 69210. You should link 380.4 (Impacted cerumen) to 69210 to support medical necessity.

To qualify for 69210, the procedure must require substantial physician effort and require instrumentation to remove the impacted cerumen, according to Medicare.