Wiki 69210 w/OV

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mrsjehu

mrsjehu

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We have a large Medicare patient population in our practice. Many of our patients have impacted Cerumen. Doctor has been doing his exam and then noticing this issue and cleaning them using instrumentation. I am putting the correct modifiers on, however the 69210 is being denied.

Is anyone else having this issue? If so what is the fix?

We are considering doing an ABN. Dr. is a little annoyed as he knows of ENTs that are getting paid for this. I am thinking almost that the patient needs to come in just for that?? Any help would be greatly appreciated!
 
mrsjehu said:
We have a large Medicare patient population in our practice. Many of our patients have impacted Cerumen. Doctor has been doing his exam and then noticing this issue and cleaning them using instrumentation. I am putting the correct modifiers on, however the 69210 is being denied.

Is anyone else having this issue? If so what is the fix?

We are considering doing an ABN. Dr. is a little annoyed as he knows of ENTs that are getting paid for this. I am thinking almost that the patient needs to come in just for that?? Any help would be greatly appreciated!
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What are all the codes on the claim , and what does the denial state, and what dies the procedure note state?
 
Some of the claims are
99213-25
69210
dx code on the 69210 is the impacted cerumen 480xx off the top of my head.

The note states that the patient came in for other issue and that in the course of the exam Dr. noticed that he had impacted cerumen. Ears were cleaned using instrumentation and that patient noticed improvement in hearing after they were cleaned. I would have to go back and pull up the EOBs to see why they were denied exactly. If memory serves correctly it was basically saying that it was part of the exam. Looking up information I have been finding conflicting reports. Some state that Medicare only allows 69210 1x per lifetime. Other information I am finding is saying that it should be paid. So confused!
 
I found the denial code. It is stating that it is inclusive of the office visit. Even though there is a -25 on the office visit.
 
You may need to appeal with documentation. If you look at the documentation requirements for 69210 it indicates the physician should document that the cerumen is impacted, dry, hard and required the use of instrumentation. If the cerumen is soft and the physician uses instrumentation, Medicare will not consider that as a payable diagnosis.
 
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