Wiki ear lavage ( bilatteral) and office visit

[Pillow1]

Medicare denied the 69210 59+50 but didnt process the 99214 yet
I originally billed
99214
62910 59-50
and realized that I wanted to bill it as
99214 added 25
and 69210 50
...is that the correct way to bill?

 

[OCD_coder]

Ear lavage is not billable with a 69210, now or even prior to 2014. The new code description, effective 1/1/2014, now clearly states "with instrumentation". This is what has always been expected performed to support reporting.

If a curette was used, bilaterally. A modifier 25 is needed on the E&M, no modifier on the 69210. A modifier 50 is only allowed with commercial/non-government payers for bilateral cerumen removal. Medicare does not agree with the AMA CPT guidelines and will only pay for it once, whether unilaterally or bilaterally.

Probably just the 99214 would be billable with how you are describing the scenario.

 

[MandyFlagg]

With the description change (unilateral) are you sure that CARE will only pay once? Can you refer me to documentation?
Thanks for the input

 

[RebeccaCross*]

Page 74341

We disagree with the assumption by the AMA RUC that the procedure will be furnished in both ears only 10 percent of the time as the physiologic processes that create cerumen impaction likely would affect both ears. Given this, we will continue to allow only one unit of CPT 69210 to be billed when furnished bilaterally. We do not believe the AMA RUC's recommended value reflects this and therefore, we will maintain the CY 2013 work value of 0.61 for CPT code 69210 when the service is furnished.


http://www.gpo.gov/fdsys/pkg/FR-2013-12-10/html/2013-28696.htm

 

[MandyFlagg]

Thank you!

 

[Pillow1]

Thank you for that information. It helps out tremendously!