Wiki Bilateral code 69210 and G0268

[maebelle@gmail.com]

We have had issues with code 69210 billing it out bilaterally but I think we are straight on that now. I realize Medicare and Medicaid are not going to pay for it bilaterally. My question now is regarding code G0268. We also use this code other commercial insurances with the pt has a hearing test on the same day as having removal of impacted cerumen. Does anyone know if this code will be payable bilaterally by commercial payers?

 

[OCD_coder]

G0268 is a bilateral code whether one or both ears are evaluated and should only be reported for a maximum of one units per DOS, this in the code description.

 

[mblair]

69210

The description for 69210 has been modified for 2014. Look at your CPT book. It is now unilateral and is appropriate to report bilateral procedure with the modifier 50.

However, the description for G0268 has not changed (one or both ears).

 

[DrJ]

mblair,
50 modifier is not recommended by the AAOHNS.
Medicare is rejecting it if it has a 50 modifier.

 

[jbROYALbg]

69210 Cerumen Removal

Per Cigna, cerumen removal will not be paid unless the medical records indicate the instruments used to remove the wax. Also they do not recognize the 50 modifier and told us to bill 69210-59. A few physicians have spoken to our local rep and she is working with Cigna to see what can be done about this.