hsmith67
Guru
I have a debate going that I would like some feedback on and please provide references whenever possible.
Primary care setting, patients with ear pain, problems hearing, etc that upon physical exam have impacted cerumen.
Scenario 1: Provider irrigates patient ear/s, uses sucker, whatever he/she can to get impacted cerumen out of ear. This is after chief complaint, history, physical exam, etc. Provider spends 35 minutes to 1 hour face total face with patient.
Scenario 2: Provider does same as scenario 1 above, but also uses curette to remove cerumen. Provider spends 35 minutes to 1 hour total face to face with patient.
Scenario 3: Provider does chief complaint, history, physical exam, etc and advises nurse to remove cerumen. Nurse uses irrigation/sucker, etc. and removes impacted cerumen. Provider spends 15-20 minutes total face to face with patient, nurse then spends 30 minutes to 1 hour total face to face with patient.
I have had no success getting 69210 paid in any scenario except when billed by itself (no E&M code billed). Even though the CPT book does not define 69210 as using "curette or surgical instruments" I have read that is what payers expect and how they interpret 69210. My thought is to bill 99213 and 99354 for additional time spent for Scenario 1 and 2. However, if the nurse performs the procedure in Scenario 3 then I can only bill 99213 and the 30 minutes to 1 hour face to face time spent by the nurse is 100% "freebie" as there is no way to bill that time (can't bill 99354 for nurse face to face time as nurse is not "physician or other qualified health care professional"). So procedure is done essentially for free.
I just want to get my providers the most reimbursement possible for time spent (by all parties) and play by the rules. So...Please, let me know your thoughts.
Thanks for any help/references you can provide.
Hunter Smith, CPC
Primary care setting, patients with ear pain, problems hearing, etc that upon physical exam have impacted cerumen.
Scenario 1: Provider irrigates patient ear/s, uses sucker, whatever he/she can to get impacted cerumen out of ear. This is after chief complaint, history, physical exam, etc. Provider spends 35 minutes to 1 hour face total face with patient.
Scenario 2: Provider does same as scenario 1 above, but also uses curette to remove cerumen. Provider spends 35 minutes to 1 hour total face to face with patient.
Scenario 3: Provider does chief complaint, history, physical exam, etc and advises nurse to remove cerumen. Nurse uses irrigation/sucker, etc. and removes impacted cerumen. Provider spends 15-20 minutes total face to face with patient, nurse then spends 30 minutes to 1 hour total face to face with patient.
I have had no success getting 69210 paid in any scenario except when billed by itself (no E&M code billed). Even though the CPT book does not define 69210 as using "curette or surgical instruments" I have read that is what payers expect and how they interpret 69210. My thought is to bill 99213 and 99354 for additional time spent for Scenario 1 and 2. However, if the nurse performs the procedure in Scenario 3 then I can only bill 99213 and the 30 minutes to 1 hour face to face time spent by the nurse is 100% "freebie" as there is no way to bill that time (can't bill 99354 for nurse face to face time as nurse is not "physician or other qualified health care professional"). So procedure is done essentially for free.
I just want to get my providers the most reimbursement possible for time spent (by all parties) and play by the rules. So...Please, let me know your thoughts.
Thanks for any help/references you can provide.
Hunter Smith, CPC
