Wiki cerumen removal

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Can I bill for an E/M and cerumen removal..if so, why....if not, why. For some reason it is such a grey line between being able to bill the e/m and the procedures at times. Can we choose to just bill the e/m if both shouldn't be billed? In this case the e/m would bring more revenue than just the cerumen removal and a full e/m was done. I have the same situation with 12001 laceration repairs, sometimes the e/m warrants a 99204 because of prescriptions given and extent of exam (which pays more than a 12001 laceration repair), but the main reason they are there is for laceration repair. I need some clarification.


vitals, HIP, CC all taken

Pt is a 47 yo male who is here with c/o right ear discomfort and rapid loss of hearing. No recent fever or illness.

REVIEW OF SYSTEMS:. Otherwise as stated above, a 14-point review of systems was conducted and negative.

General: Communicates without difficulty, well nourished, no acute distress.
Head: Normocephalic, no evidence injury, no tenderness, facial buttresses intact without stepoff.
Ears: EAC: Cerumen right, removed under microscopy, normal once cleared. TM: Intact, no fluid, mobile bilaterally.
Eyes: No scleral icterus, conjunctivae clear.
Neuro: CN II exam reveals vision grossly intact. No nystagmus at any point of gaze.
Nose: External evaluation reveals normal support and skin without lesions. Dorsum is intact. Anterior rhinoscopy reveals healthy pink mucosa over anterior aspect of inferior turbinates and intact septum. No purulence noted.
Oral: Oral cavity and oropharynx are intact, symmetric, without erythema or edema. Mucosa is moist without lesions.
Neck: Full range of motion without pain. There is no significant lymphadenopathy. No masses palpable.

DIAGNOSIS:
Impacted cerumen [380.4]

PROCEDURE: Cerumen removal

Cerumen removed using curette under microscopy with immediate restoration of hearing in patient.

DISCHARGE:.


Recommend following up with PCP or here for blood pressure recheck.
Return prn failure to improve.
 
There was a great article on this exact situation on page 24 of AAPC's September issue of Healthcare Business Monthly. If you have access to it, it is well worth reading! In the scenario given above, it would be appropriate to bill both the E/M and the cerumen removal. This is because the cerumen is described as impacted and because the cerumen was removed with a curette. If the cerumen is removed only using irrigation or lavage, then it is included in the E/M service. Use of code 69210 requires that the cerumen be specifically documented as impacted and that it also requires the use of instrumentation. I really recommend reading the article as it provides much more information.
 
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