Wiki TOC

[1christinepeters]

If patient comes in for TOC 99495 or 99496 and also has an ear wash, 69210, completely separate, what modifier will pay? It's bundling and paying only the ear wash. But they are unrelated. Best advise? Thank you.

 

[SharonCollachi]

69210 is not an "ear wash", it is removal of impacted cerumen requiring instrumentation by a licensed professional.

Are you sure no one else billed TCM?

 

[kellysittig]

If you put a 25 on the TOC it should pay like that. I never put modifiers on the 69210 other than LT/RT.

-Kelly

 

[1christinepeters]

69210 is not an "ear wash", it is removal of impacted cerumen requiring instrumentation by a licensed professional.

Are you sure no one else billed TCM?

Sorry, yes, impacted cerumen. Removal was done. I am certain no one else billed. It's bundled is the denial.

 

[1christinepeters]

If you put a 25 on the TOC it should pay like that. I never put modifiers on the 69210 other than LT/RT.

-Kelly

We were advised a -25 was not to be used on TCM. Claims have denied with -25 and flu shot billed. 99496, 90471, 90686... Where are the rules and better descriptions on TCM? I've looked for the MLM matters on medicare, but it's temporarily down, for about 4 weeks now.

 

[1christinepeters]

Any input on TOC and flu shot? Finding the TOC gets denied and bundled with 90471 with a -25 on the TOC. Then TOC is CO97. Any input fellow coders?