Pediatric Coding Alert

Question: A patient presented with ear pain. The doctor used a curette to remove impacted cerumen before being able to visualize tympanic membranes. He diagnosed an ear infection. Can we bill an office visit and modifier along with 69210?Michigan SubscriberAnswer: Theoretically, you don't need a modifier, though some insurers insist on it. Start by billing the appropriate E/M from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) and 69210 (Removal impacted cerumen [separate procedure], 1 or both ears). Include diagnosis 380.4 (Impacted cerumen). If the payer rejects your claim, resubmit the E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).Caution: Before reporting 69210, verify there was true impacted cerumen (blocking the pediatrician's view of the tympanic membrane) and the physician used instrumentation and direct visualization [...]