Wiki 69210 cerumen impaction removal

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kvandexter

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Has anyone else heard that we can start billing 69210 with a 50 modifier as of 1/1/2014?
 
Yes, Please review 2014 CPT Book page 384, left side at the bottom, See Parenthetical Notation:
"(For bilateral procedure, report 69210 with modifier 50)"
Teresa :)
 
There are several changes to the 69210 CPT code. One is that it is now unilateral, and second the description is very specific to using instrumentation.

CPT Description:
Removal impacted cerumen requiring instrumentation, unilateral

Lay Description:
Under direct visualization, the physician removes impacted cerumen (ear wax) using a cerumen spoon or delicate forceps. If no infection is present, the ear canal may be irrigated.

Coding Tips:
This code has been revised for 2014 in the official CPT description. Report this procedure for removal of cerumen impaction. It should not be reported for simple irrigation. This separate procedure by definition is usually a component of a more complex service and is not identified separately. When performed alone or with other unrelated procedures/services it may be reported. If performed alone, list the code; if performed with other procedures/services, list the code and append modifier 59.

This is a unilateral procedure. If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code while others require identification of the service only once with modifier 50 appended. Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image).Code 69210 should not be reported for removal of PE tubes.
 
69210

Greetings~

While the code changed to allow a -50 modifier per AMA\CPT, the MUE for this code has not been updated on the RBRVS to "2", nor has the Modifiers "allowed" been changed to include "-50".

Additionally, G0268 has not had it's description changed to reflect the change.

Thoughts?

Christine
 
69210

I placed a call to Medicare (IL). They have had to move this up the ladder to a 3rd level tier. The issue is not resolved and will take 30-45 for them to "review" the issue. I have been told to keep billing it correctly with the 50 as they may "figure it out" before they resolve my issue and will fix all the denied claims. Hopefully this will help us all out :)
 
Last edited:
69210 and Medicare

Just sharing new information I discovered that all may not be aware of. Medicare will only pay for one unit of the 69210, ever.

Here?s what Medicare had to say in the Federal Register:

?We disagree with the assumption by the AMA RUC that the procedure will be
furnished in both ears only 10 percent of the time as the physiologic processes
that create cerumen impaction likely would affect both ears. Given this, we will
continue to allow only one unit of CPT 69210 to be billed when furnished
bilaterally. We do not believe the AMA RUC?s recommended value reflects this
and therefore, we will maintain the CY 2013 work value of 0.61 for CPT code
69210 when the service is furnished.?
 
We have had all our charges for this code deny since the first of the year when we added the modifier 50. My computer locks up everytime I try to pull up the federal register to search for info regarding this code. Can you provide a link to the information you just posted, OCD_coder? Trying to get some solid information that I can share with my doctors...any help would be appreciated. Thank you!
 
Commercial Payer Denials?

Thank you everyone for your comments on Medicare.

I am wondering if anyone is getting any denials from the commercial carriers as well when billing 69210 with the 50 modifier for 2014?



Jennifer M. Connell, BA, CPC, CENTC
 
Here is also the Excerpt from the Academy as well.


Based on CMS' guidance, the Academy recommends that members NOT report 69210 using modifier -50, as MACs are denying these claims entirely and not paying for even one unit reported. This requires providers to reprocess the denied claim which takes additional time and administrative effort. CMS has stated they will not issue a transmittal to providers at this time, and have asked the Academy to share this coding directive with members. We are working with the Agency to provide them with concrete data related to the percentage of time 69210 is provided bilaterally, in hopes that this will allow them the necessary evidence to revisit this payment policy in CY 2015. As the dialogue continues with CMS, we will keep members apprised of our progress on these advocacy efforts via the weekly e-news, monthly HP-Update, and printed Bulletin. Please email us with any questions at: healthpolicy@entnet.org.
 
I have to say that in my general practice clinic, I have billed for this procedure 6 times since the beginning of the year and every one has been unilateral.
Just saying.
Karen Hill, CPC, CPB, CPMA, CMB
ICD-10 Proficient
AHIMA Approved ICD-10-CM Trainger
Anchorage, Alaska
 
Medicaid Reimbursement for 69210

Medicaid Requires 69210 to be reported with RT and/or LT modifiers. If bilateral, should be reported on two lines with RT on one line and LT on another. Certain restrictions required. Refer to the April 2014 Medicaid Provider Manual Chapter 28 pg. 28-10:
Payment may be made for impacted cerumen (when ALL of the following are met): 1) the service is the sole reason for the patient encounter, 2) the service is personally performed by the physician or non-physician practitioner (i.e. nurse practitioner, physician assistant), 3) the service is provided to a patient who is symptomatic, and 4) the documentation illustrates significant time and effort spent in performing the service.
Effective January 1, 2014, CPT code 69210 is a unilateral procedure. Please refer to section 28.6.3 for billing of bilateral procedures.
Payment consideration may be made for both the procedure and the E&M services if ALL of the following conditions exist: 1) The nature of the E&M visit is for something other than removal of impacted cerumen. 2) During an unrelated patient encounter (visit), a specific complaint or condition related to the ear(s) is either discovered by or brought to the attention of the physician/non-physician practitioner by the patient. 3) Otoscopic examination of the tympanic membrane is not possible due to a cerumen obstruction in the canal. 4) The removal of impacted cerumen requires the expertise of a physician or non-physician practitioner. 5) The procedure requires a significant amount of the physician?/non-physician practitioner?s effort and time. 6) Documentation is present in the patient record to identify the above criteria have been met.
Limitations:
? Removal of impacted cerumen performed by someone other than the physician or non-physician practitioner is not billable.
? Simple cerumen removal performed by the physician or office personnel (e.g., nurses, office technicians) is not medically necessary and therefore, not separately payable.
? An E&M service and the removal of impacted cerumen are not separately payable when the sole reason for patient encounter is for the removal of impacted cerumen.
? The patient is asymptomatic (e.g. denies pain, hearing loss, vertigo. etc.).
? Visualization aids such as, but not necessarily limited to, binocular microscopy, are considered to be included in the reimbursement for 69210 and should not be billed separately. Most patients do not require medically necessary disimpaction of cerumen by a physician.
 
I have been using mod -RT & -LT with all commercial insurance companies and it has been getting paid. Medicare is the only insurance not paying bilaterally.
 
2014 cpt 69210

We are receiving denials from Medicare (CGS/Ohio) for all dates since 1-1-14 and also from United Healthcare PPO Options.
 
Irrigation only

Is there ever a situation where irrigation only can be charged such as symtoms of hearing loss due to ceremun impaction?
 
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