Otolaryngology Coding Alert

Question: I know the descriptor for cerumen removal code 69210 has changed for 2014. Do the changes also apply to G0268?

Florida Subscriber

Answer: You report G0268 (Removal of impacted cerumen [one or both ears] by physician on same date of service as audiologic function testing) for a Medicare patient when the physician removes impacted cerumen on the same day that audiology is performed. Its descriptor has not changed – you still report G0268 for either one or both ears.

When reporting cerumen removal for a Medicare patient, submit G0268 if audiology is also performed that day. Report 69210 (Removal impacted cerumen requiring instrumentation, unilateral) if no audiology is performed. G0268 remains a unilateral/bilateral code, so you don’t need to append modifier 50 (Bilateral procedure) if the service is performed in both ears.

Unfortunately, Medicare is treating 69210 just like G0268 and paying it the same amount whether it was performed unilaterally or bilaterally. Some Medicare carriers are actually denying 69210 if it is submitted with a 50 modifier even though AMA CPT® calls for the 50 modifier when performed bilaterally,