lynji79
New
I would like the opinion from other coders on this scenario:
Patient presented to our urgent care center, where he was seen by a provider who is new to him. (He has previously been seen by other providers within the group practice.) Patient had a comprehensive history and comprehensive exam done. Patient received a prescription for pain medication, and he had impacted cerumen removed bilaterally by curette. I coded this as 99214-25 and 69210-50. My supervisor argues that we cannot bill the 69210, with her reasoning being that BCBS denied the charge as incidental, and that the diagnosis code for the E/M ended up only being the impacted cerumen, with nothing else wrong with the patient. My argument is that just because something isn't "payable" by a particular carrier doesn't mean that it isn't "billable." The patient did receive a full work-up prior to having the cerumen removed, so I feel that it justifies billing both services. What does everyone else think?
Patient presented to our urgent care center, where he was seen by a provider who is new to him. (He has previously been seen by other providers within the group practice.) Patient had a comprehensive history and comprehensive exam done. Patient received a prescription for pain medication, and he had impacted cerumen removed bilaterally by curette. I coded this as 99214-25 and 69210-50. My supervisor argues that we cannot bill the 69210, with her reasoning being that BCBS denied the charge as incidental, and that the diagnosis code for the E/M ended up only being the impacted cerumen, with nothing else wrong with the patient. My argument is that just because something isn't "payable" by a particular carrier doesn't mean that it isn't "billable." The patient did receive a full work-up prior to having the cerumen removed, so I feel that it justifies billing both services. What does everyone else think?