Otolaryngology Coding Alert

Question: We have a few insurance companies who deny an office visit with 69210. We used modifier 25. Any other suggestions? California Subscriber Answer: You should report an E/M service on the same day as removal of impacted cerumen only when the E/M is for a separate and different condition from the impacted cerumen which required the 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) -- for instance, if the patient had a cough. When your ENT's documentation supports a separate, significant E/M service in addition to cerumen removal, you should (and rightly did) append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M service code. Unlike other uses of modifier 25, 69210 is one of the few codes which will not accept only one diagnosis for both the E/M and [...]