Otolaryngology Coding Alert
Double-Check Your Encoders for Accurate NCCI Edit Information
Question: Our encoder shows that it is OK to bill cerumen impaction removal (69210) and a comprehensive audiometry threshold evaluation and speech recognition (92557) and tympanometry (92567) on the same date of service (DOS). However, an insurance company (BCBS) performed an audit and is taking the money back for the 69210 stating it is bundled. Should we dispute this denial? New Jersey Subscriber Answer: You should always make a habit of performing a National Correct Coding Initiative (NCCI) edits check on two or more services performed at the same patient encounter. In this example, the encoder is incorrect in telling you that you may bill 69210 (Removal impacted cerumen requiring instrumentation, unilateral) alongside 92557 (Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)) and 92567 (Tympanometry (impedance testing)). In fact, NCCI edits show that 69210 has a modifier “0” status when paired with both 92557 and 92567 — meaning that you should not bill these two services together under any circumstances. Since 69210 is the column 2 code in both edits, you will consider 69210 bundled into each respective service.
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