Question: My coworker told me that when reporting H61.21 or H61.22, I still must append a laterality modifier, even though laterality is already built into the code. Is that correct?
AAPC Forum Participant
Answer: Your coworker may be correct, but this will all depend on whether the pediatrician removed the cerumen. If that answer is yes, then even though H61.21 (Impacted cerumen, right ear) and H61.22 (… left ear) already have laterality built in, you still need to report the CPT® code that most closely describes the actual procedure your provider performed and that corresponds with the laterality specified in the ICD-10-CM code. CPT® has two codes for removal of impacted cerumen:
This would mean you would append one of the following modifiers to your claim:
If the provider did not remove the cerumen during the visit, then no modifier is necessary for the CPT® codes you choose.
Take note: Different payers may have other preferences for how you report the removal of impacted cerumen from both ears. Some might ask for two entries, with the second one adding modifier 50 on the second line item. Others might want you to use two entries as well, but with the RT modifier on one line and the LT modifier on the other. Therefore, be sure and review the specific guidelines of the payer before submitting your claim for this procedure.
Lindsey Bush, BA, MA, CPC, Development Editor, AAPC
