Wiki Medicare ear wash

[mbuskirk@rrohio.com]

How do I bill a bilateral ear wax removal and get it pd by Medicare??? No matter what I do it doesnt get pd. I have a 99213 w/ 25 mod. I have tried it with left and right modifer, I have tried it with the bilateral modifier.....DENIED!! HELP!! Please and Thank you!

 

[RebeccaWoodward*]

How do I bill a bilateral ear wax removal and get it pd by Medicare??? No matter what I do it doesnt get pd. I have a 99213 w/ 25 mod. I have tried it with left and right modifer, I have tried it with the bilateral modifier.....DENIED!! HELP!! Please and Thank you!

An ear lavage does not support 69210. If this was a true cerumen removal, there are specific guidelines in place in order for this service to be paid. Rather than reposting the guidelines, I've provided the link that provides this information. Pam has provided the guidelines. If the documentation supports this service, you will probably need to appeal with documentation. Medicare will be looking at the E/M to determine if this is a separate, distinct E/M. They will also focus on the ear wax removal to determine if the guidelines have been met.

https://www.aapc.com/memberarea/forums/showthread.php?p=264132#post264132

 

[hrivera17]

69210 is not billable as a bilateral procedure. The code is for 1 or both ears. See CPT description. In other words if the doc removes impacted ear wax from both ears they are both included in 69210. Hope that helps