Wiki Cerumen Removal Unsuccessful

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dballard2004

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The NP removed the cerumen with a curette after irrigation from one ear, but it was not removed from the other ear. The provider removed the additional charge for the CPT 69210 because it was only removed from one ear and unsuccessful in the other ear. This patient also had an e/m code for another diagnosis. My questions are:

I realize that the E/M would be coded with -25, and we should have coded 69210 for the cerumen removal for the one ear, but if was unsuccessful from the other ear, how do we capture that?

If the patient returned in 3 days and had the cerumen successfully removed via irrigation and curette, could we bill for the cpt code of 69210 again?
 
I think you can bill the E/M and 69210 for the first day, since 69210 says 1 or both ears. Nothing as far as billing would need to be reported for the unsuccessful removal in the other ear that day. Then on the next visit, if it qualifies for 69210, that would be billed alone for the other ear.
 
Good question-

I looked at one of my "Pink Sheets" (peds) and they recommended modifier 53 for the unsuccessful attempt. Does make you wonder if the carrier will actually pay for it. (?)

As for the return visit...if the documentation met the "procedure" requirements, I don't see an issue billing for it again. 69210 has zero global days.
 
Would you use the 53 only if the attempt was made on either ear and couldn't be done at all? You wouldn't use the 53 if you successfully performed in on one ear, right?
 
You've got my brain on overload now....

So...69210 is inherently a bilateral procedure (based on it's description). It wouldn't seem logical to be able to bill both since, technically, you can't bill bilaterally...

99213
69210 (for the successful procedure)
69210-53 (for the unsuccessful procedure)

But...since the description states one or both ears, does the extra work allow for it if documented properly??

I dont' know....I'm a little torn on this one...... :confused:
 
CPT 69210 specifically states Removal impacted cerumen (separate procedure), 1 or both ears; before I move on, a word of caution, according to Medicare guidelines, a "skilled physician" must remove impacted cerumen; that being said, if all medical documentation supports an E/M with cerumen impaction removal, you can bill the E/M w/mod 25 and then 69210; you are over-thinking the situation, CPT says one or both ears; as the patient returned in 3 days and there is zero global, bill CPT 69210 again for that encounter. My co-worker and I have this saying when we get hung up on a situation like this, stop splitting hairs; you have everything you need to back up your claims.

Jennifer
CT ENT
 
Jennifer, you are 100 % correct. The code reads one or both ears. If you do one or both ears you can only code procedure once. At any later date the procedure can be rebilled, but only once per session no matter how many ears!!!]
 
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