Wiki Help!! Medicare billing

[mbuskirk@rrohio.com]

We did a bilat ear irrigation on a Medicare pt and I have billed it with every modifier known to man....eg: 50,51, right side, left side. Nothing is getting paid. No office visit charged just irrigation. I know it cant be this hard. I must be getting old! Any help is much appreciated.

Thank you
Mary

 

[Donna T]

What was the reason for the denial? Typically, Medicare will not cover simple, non-impacted earwax removal. CMS requires that physicians meet the following criteria for reimbursement of the removal of impacted cerumen:

1.The procedure is the sole reason for the patient encounter;
2.A physician or non-physician (nurse practitioner, physician assistants, or clinical nurse specialist) carries out the treatment.
3.The patient in question is symptomatic; and
4.The supporting documentation shows significant time and effort spent performing the service.

Hope this is helpful! Donna

 

[tdml97@yahoo.com]

69210 w/ mod 50 qty 1 diag 3804

 

[Herbie Lorona]

Yes more info would be needed to be able to tell why they are not being paid but like Donna said it has to meet certain criteria. If a medical assistant is doing just a simple ear irrigation that is something that is included with an office visit and you don't bill 69210. Also please note that a 69210 wouldn't need a modifier 50 because the description states 1 or both ears.