Wiki Rmvl impacted cerumen-Help!

[Marjoriecoop]

69210 is now a unilateral code, and somehow there's no explanation for what to do when a doc removes earwax from both ears. One payer says "it is unilateral only" and will not accept mod 50. How to get paid for cleaning out two ears?

 

[danachock]

Removal of Impacted Cerumen

Hi, oh my ~ off the top of my head I remember getting a notice last week on this. I have it saved if you would like me to forward it to you. You will no longer use modifier 50 for bilateral. It is for a unilateral or bilateral procedure.
If I also remember it has to state that the cerumen has to be impacted to receive reimbursement.
Feel free to email me directly at danachock@brainerd.net
Thanks,
Dana Chock, CPC, CCA, CANPC, CHONC
Anesthesia, Pathology, and Laboratory Coder

 

[Christinepfeifer]

Learned the other day that our MAC (NGS) wants RT and LT on two lines. The MUE has not been removed yet. In addition, the description includes the need for instrumentation and primary dx must be impacted cerumen.

 

[dtlandry67]

Here is the Noridian guidance that just came out:
Effective in 2014, the American Medical Association (AMA) CPT manual identifies CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) as a unilateral procedure. CMS has determined that, regardless of unilateral or bilateral, 69210 will remain bilateral and will allow only one unit per date of service billed. Appending modifier 50 is not acceptable.

The work Relative Value Unit (RVU) was maintained at 0.61.

For further details, consult the Federal Register/Volume 78, No. 237 / Tuesday, December 10, 2013/Rules and Regulations 74341(14) Cerumen Removal (69210) at http://www.gpo.gov/fdsys/pkg/FR-2013-12-10/html/2013-28696.htm.