Pediatric Coding Alert

Question: When can we bill for cerumen removal in addition to an office visit?

Louisiana Subscriber  
Answer: The answer depends on two factors: the diagnosis and the reason the child came in for the visit.
 
The only diagnosis code for cerumen removal is 380.4. When billing cerumen removal (69210, removal impacted cerumen [separate procedure], one or both ears), be sure to link the service with the impacted cerumen diagnosis on the claim form. Link a separate diagnosis to the office visit.
 
Tip: Do not link an otitis media diagnosis code to cerumen removal. Many insurance companies do not view otitis media is a reason for removing cerumen.
 
If the child comes in solely for removal of the ear wax, do not bill for an office visit in addition to the removal. If the child comes in for an upper respiratory infection, and you check the ears but cannot visualize the canals due to excess wax, bill for the cerumen removal as well as the office visit. Link 380.4 to 69210, and link the diagnosis code for the URI (465.9, acute upper respiratory infections of multiple or unspecified sites; unspecified site) to the E/M visit, with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended. 
 
-- Answers to You Be the Coder and Reader Questions contributed by Richard H. Tuck, MD, FAAP, founding chairman, AAP coding and reimbursement committee, practicing pediatrician, Zanesville, Ohio; Thomas Kent, CMM, CPC, president, Kent Medical Management, Dunkirk, Md.; Garnet Dunston, CPC, MPC, Dunston Enterprises, Phoenix; Diana Arbes, CPC, reimbursement analyst, Children's Hospital Pediatric Physicians of the Oklahoma University Health Sciences Center, Oklahoma City; and Brenda Mason, head biller, Northpoint Pediatrics, Indianapolis.