Pediatric Coding Alert

The NCCI fight is over for one payer.

If you’ve been frustrated by halted reimbursement for 69210 (Removal impacted cerumen requiring instrumentation, unilateral) with an E/M service, you’ll be glad to finally receive some good news on that front. 

The scoop: Cigna has changed its policy regarding claims that include 69210 with an office-based E/M code (99211-99215). Any claim with these codes and modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) will be reprocessed by the payer. Going forward, Cigna will reimburse providers when they append modifier 25, with no documentation necessary with submission. 

Note: CPT® 2014 changed 69210 and it is now a unilateral procedure. If both ears require cerumen removal, report 69210-50 to cover the cerumen removal for both ears.

For more on this issue, visit the website of the American Academy of Otolaryngology-Head and Neck Surgery at www.entnet.org/content/news-and-updates-private-payers.