Wiki Cerumen Removal/ Office Visit

[Sheila Trout]

I am looking for information on billing for cerumen removal or an office visit and am not finding clarification.
Example: Patient makes an appointment to have their ears cleaned. We have never seen that patient before so he/she is a new patient to us. if the provider chooses to exam the patient's ear and perform the cerumen removal that day, i realize we cannot bill for both but doesn't it make more sense if the documentation supports it to bill for the exam and leave the cerumen removal off? Can anyone help me find the clarification on this. Any help is appreciated. thank you

 

[thescientist8]

If cerumen removal is the sole reason for the visit, then E/M service will be included in the fee for the removal of impacted cerumen. E/M is not separately payable. You can bill for for both (E/M and removal of cerumen) if the diagnosis of the E/M is other than the removal of impacted cerumen.

 

[thescientist8]

If cerumen removal is the sole reason for the visit, then E/M service will be included in the fee for the removal of impacted cerumen. E/M is not separately payable. You can bill for for both (E/M and removal of cerumen) if the diagnosis of the E/M is other than the removal of impacted cerumen.

And adding 25 mod on E/M

 

[AAPC123159]

I am looking for information on billing for cerumen removal or an office visit and am not finding clarification.
Example: Patient makes an appointment to have their ears cleaned. We have never seen that patient before so he/she is a new patient to us. if the provider chooses to exam the patient's ear and perform the cerumen removal that day, i realize we cannot bill for both but doesn't it make more sense if the documentation supports it to bill for the exam and leave the cerumen removal off? Can anyone help me find the clarification on this. Any help is appreciated. thank you

Sheila- Talk to the provider to see if any ear pain or ear blockage encountered . If so, they must be documented. More than likely, insurance carrier will process and allow/pay the procedure first, but will be asking documentation on the E/M. So be ready to submit them once requested...Hope this helps and good luck!!