Wiki Cpt 69209

[kyannekis]

Is anyone billing this new code to MCR/other payers and being paid in the ED setting? I would think it is included in the E/M since the nurse does the irrigation.

 

[thomas7331]

This code has a PC/TC indicator of 5 (incident to code) on the Medicare physician fee schedule which is defined to mean that "payment may not be made by carriers for these services when they are provided to hospital inpatients or patients in a hospital outpatient department." So under Medicare rules, this code should never be paid to a physician in a facility place of service - if it is being paid, I expect it's an error and will be recovered at some point.