cle3761
Guest
Does anyone know how many times per year a medicare patient can have 69210 and is bilateral mod 50 used or RT, LT thanks so much
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Wiki cpt 69210
- Thread starter cle3761
- Start date
SharonCollachi
Guest
Interesting short article from 2014 on what Medicare is paying for bilateral (things may be different now, although I saw the same info as recently as 2019).
I could find no information on frequency other than one unit/day. I would think if it is impacted, it can be removed. Make sure the documentation clearly indicates the impaction, such as the descriptions shown in this blurb (the bullet points):
Payers typically will not cover simple, non-impacted earwax removal. This work is included in E/M services and shouldnot be reported separately with E/M services when performed. If impacted earwax is removed by irrigation or lavage only, use CPT 69209. CPT 69210 should NOT be reported for lavage.
Requirements for reporting cerumen removal: CPT defines cerumen as “impacted” if one or more of the following conditions are present:
•cerumen impairs the examination of clinically significant portions of the external auditory canal, tympanic membrane (unable to see the entire tympanic membrane), or middle ear condition;
•extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc.;
•cerumen is associated with foul odor, infection, or dermatitis; or
•obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician or non-physician practitioner skills
2) InstrumentationA key factor in determining whether code 69210 should be reported is what instruments are utilized to remove the impacted ear wax. In this context, instrumentation is defined as the use of an otoscope and other instruments such as wax curettes, wire loops, or suction plus specific ear instruments (e.g., cup forceps, right angle hook). Accompanying documentation should indicate the equipment required to provide the service.
I could find no information on frequency other than one unit/day. I would think if it is impacted, it can be removed. Make sure the documentation clearly indicates the impaction, such as the descriptions shown in this blurb (the bullet points):
Payers typically will not cover simple, non-impacted earwax removal. This work is included in E/M services and shouldnot be reported separately with E/M services when performed. If impacted earwax is removed by irrigation or lavage only, use CPT 69209. CPT 69210 should NOT be reported for lavage.
Requirements for reporting cerumen removal: CPT defines cerumen as “impacted” if one or more of the following conditions are present:
•cerumen impairs the examination of clinically significant portions of the external auditory canal, tympanic membrane (unable to see the entire tympanic membrane), or middle ear condition;
•extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc.;
•cerumen is associated with foul odor, infection, or dermatitis; or
•obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician or non-physician practitioner skills
2) InstrumentationA key factor in determining whether code 69210 should be reported is what instruments are utilized to remove the impacted ear wax. In this context, instrumentation is defined as the use of an otoscope and other instruments such as wax curettes, wire loops, or suction plus specific ear instruments (e.g., cup forceps, right angle hook). Accompanying documentation should indicate the equipment required to provide the service.