ploegeral
New
I used to be able to put a 25 modifier on E/M code and bill 69210 (cerumen irrigation) together. It has lately been denied for invalid HCPCS combo. Can someone please advise the appropriate coding for this combination of CPT codes?
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Wiki E/M with 69210
- Thread starter ploegeral
- Start date
Pathos
True Blue
There is a really good article (although it's from 2014) written by AAPC's John Verhovshek, which covers this topic fairly well.
Basically two main factors decide whether a 69210 is considered billable and the cerumen removal is not bundled into the E/M:
Impaction:
-Cerumen impairs the examination of clinically significant portions of the external auditory canal, 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 skills.
Instruments used:
-The patient presents to the office for earwax removal, which requires
magnification provided by an otoscope or operating microscope, and instruments
such as wax curettes, forceps, or suction by the primary care physician/provider
or otolaryngologist. This latter situation occurs most commonly when impacted
cerumen completely covers the eardrum and the patient has hearing loss.
Documentation is always king, if the procedure done does not support 609210 based on the AAPC article and the two factors above, I would be hesitant to bill 609210 as the procedure was probably bundled into the E/M.
Here's another forum thread on the same topic.
Basically two main factors decide whether a 69210 is considered billable and the cerumen removal is not bundled into the E/M:
Impaction:
-Cerumen impairs the examination of clinically significant portions of the external auditory canal, 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 skills.
Instruments used:
-The patient presents to the office for earwax removal, which requires
magnification provided by an otoscope or operating microscope, and instruments
such as wax curettes, forceps, or suction by the primary care physician/provider
or otolaryngologist. This latter situation occurs most commonly when impacted
cerumen completely covers the eardrum and the patient has hearing loss.
Documentation is always king, if the procedure done does not support 609210 based on the AAPC article and the two factors above, I would be hesitant to bill 609210 as the procedure was probably bundled into the E/M.
Here's another forum thread on the same topic.
Joiaw
Networker
Who was the payer?
ljhaley@gmail.com
Networker
E/M with 69209 or 69210
Hello,
I am in Pediatrics, where impacted cerumen is a daily occurrence.
69209 for irrigation/flush
69210 for removal with currette/spoon, some find of tool.
If we cannot visualize the TM's due to impacted cerumen during an exam (PE or sick call), we cannot complete the exam thus the cerumen removal becomes medically necessary. We do the procedure and document exactly what, why and how we did the removal. We bill both the E&M service and the cerumen removal quite often.
We place a 25 modifier on the E&M service, but the key we find to avoiding denials is providing a different dx code for the E&M service from the C.R., period. Impacted cerumen is always the DX for the procedure. These visits process fine for payment
If we send both an E&M and the cerumen removal with the same dx code, regardless of documentation & modifiers, it denies. Our rule of thumb is if the issue was "just" cerumen causing ear pain/hearing issues, or kid is a known cerumen producer visit, bill just the cerumen removal, no E&M. (like you would for any other procedure where the E&M portion is built into the code) Hope this helps!
Hello,
I am in Pediatrics, where impacted cerumen is a daily occurrence.
69209 for irrigation/flush
69210 for removal with currette/spoon, some find of tool.
If we cannot visualize the TM's due to impacted cerumen during an exam (PE or sick call), we cannot complete the exam thus the cerumen removal becomes medically necessary. We do the procedure and document exactly what, why and how we did the removal. We bill both the E&M service and the cerumen removal quite often.
We place a 25 modifier on the E&M service, but the key we find to avoiding denials is providing a different dx code for the E&M service from the C.R., period. Impacted cerumen is always the DX for the procedure. These visits process fine for payment
If we send both an E&M and the cerumen removal with the same dx code, regardless of documentation & modifiers, it denies. Our rule of thumb is if the issue was "just" cerumen causing ear pain/hearing issues, or kid is a known cerumen producer visit, bill just the cerumen removal, no E&M. (like you would for any other procedure where the E&M portion is built into the code) Hope this helps!