E/M w/ cerumen removal

[nlbarnes]

Hello - I often have encounters where the provider is submitting an E/M with 69210. The dx they are submitting with the E/M is H938X1, ear fullness in addition to the ICD-10 for cerumen impaction. After cerumen removal, ear symptom improved. Advised pt to use mineral oil. Is this E/M supported?

They also submit an E/M with hearing loss, unspecified with improvement after cerumen removal. Is that supported? Again, use mineral oil, is that supported?

An audiogram may be ordered, in that case would it be supported?

 

[JDACPC]

If 69210 is documented with instrumentation (as opposed to lavage: 69209), this is billable as performed but likely will be denied for medical necessity. As far as I am aware, the only dx that covers 69210 is impacted cerumen. You may want to have a discussion with the provider to specify whether it is impacted or not.

 

[nlbarnes]

If 69210 is documented with instrumentation (as opposed to lavage: 69209), this is billable as performed but likely will be denied for medical necessity. As far as I am aware, the only dx that covers 69210 is impacted cerumen. You may want to have a discussion with the provider to specify whether it is impacted or not.

Hi - thank you for your reply. There is the dx of cerumen impaction, I forgot to include on my original post.

 

[CBLENNIE]

Hello - I often have encounters where the provider is submitting an E/M with 69210. The dx they are submitting with the E/M is H938X1, ear fullness in addition to the ICD-10 for cerumen impaction. After cerumen removal, ear symptom improved. Advised pt to use mineral oil. Is this E/M supported?

They also submit an E/M with hearing loss, unspecified with improvement after cerumen removal. Is that supported? Again, use mineral oil, is that supported?

An audiogram may be ordered, in that case would it be supported?

Did the patient only come in to be seen because of the issues with their ear because based on the limited info in your post it appears that is why the patient was seen, and I don't see how after you removal all documentation related to the impacted cerumen from the chart note there will be very little information to be used to code an E&M. However, more was done during the visit, and you remove all the information regarding the impacted cerumen you still have enough documentation to support an E&M it may be billable.

Due to the limited information in your post, it is very difficult to determine if an E&M is warranted but based on what you did document I would have a hard time as an insurance auditor finding the medical necessity of an E&M in addition to the 69210 and would be inclined to deny the E&M.

 

[nlbarnes]

Did the patient only come in to be seen because of the issues with their ear because based on the limited info in your post it appears that is why the patient was seen, and I don't see how after you removal all documentation related to the impacted cerumen from the chart note there will be very little information to be used to code an E&M. However, more was done during the visit, and you remove all the information regarding the impacted cerumen you still have enough documentation to support an E&M it may be billable.

Due to the limited information in your post, it is very difficult to determine if an E&M is warranted but based on what you did document I would have a hard time as an insurance auditor finding the medical necessity of an E&M in addition to the 69210 and would be inclined to deny the E&M.

Thank you...

 

[catherinetinkey@entmedicalservices.org]

I agree with nlbarnes post, it appears that everything the physician has done is related to that ear issue, the cerumen removal procedure includes an E/M. So unless the physician is also seeing the patient for an issue independent of the ear (reflux, sleep, sinus, thyroid, allergy) it will be hard to support an E/M with a 25 modifier.