A: The coder would report CPT code 69210 (removal impacted cerumen
Earwax
Earwax, also known by the medical term cerumen, is a gray, orange, red or yellowish waxy substance secreted in the ear canal of humans and other mammals. It protects the skin of the human ear canal, assists in cleaning and lubrication, and also provides protection against bacteria, fungi, insects, and water.
Can 69210 be billed bilaterally?
May 17, 2020 · A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Alternatively, the coder could report code 69210 twice with modifiers -LT (left side) and -RT (right side). Click to see full answer Subsequently, one may also ask, is 69210 a bilateral code?
Can You Bill an E/M code with 69210?
Aug 31, 2014 · In contrast to CPT® instructions, the Centers for Medicare & Medicaid Services (CMS) allows only one unit of 69210 to be billed when furnished bilaterally. In other words: Medicare won’t pay anything extra if you report cerumen removal bilaterally. Check with your individual payers to determine their policies. Documentation Requirements for 69210
Is 69210 an unilateral or bilateral code?
Feb 06, 2020 · How do you bill 69210 for both ears? A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Alternatively, the coder could report code 69210 twice with modifiers -LT (left side) and -RT (right side).
Do you need a modifier for 69210?
Oct 01, 2015 · If the patient has pain in the external ear as his/her only complaint and the removal of cerumen addresses that complaint, one should bill only for removal of the cerumen, CPT code 69210. If the patient also has symptoms of otitis media requiring further evaluation, then it may be justified to also bill for an E&M service with modifier –25.
Does CPT 69210 need a modifier?
When you are using 69210 for ear wax impaction, it is appropriate to use an E/M code (with modifier -25) if the patient received a true evaluation and management for a separate problem (such as bronchitis or pharyngitis) or for complicating problems (such as dizziness or otitis media).Sep 1, 2007
Does Medicare pay 69210?
Medicare cannot reimburse audiologists for CPT code 69210 or HCPCS code G0268 under any circumstances.
Can 69210 be billed with 2 units?
CMS went on to say, “Given this, we will continue to allow only one unit of CPT 69210 to be billed when furnished bilaterally.” Consequently, CMS elected to maintain the 2013 work value of 0.61 for CPT code 69210 when the service is furnished.Feb 11, 2014
How do you bill bilateral ear lavage?
CMS does allow us to bill a bilateral procedure for cerumen removal by lavage using 69209-50. Finally, note that some payers may stipulate “advanced practitioner skill” is necessary to report removal of impacted earwax (i.e., payers may require that a physician provide 69209, 69210).Mar 1, 2016
Can CPT code 69210 be billed with 50 modifier?
For many payers, a bilateral procedure may be reported using a single unit of 69210, with modifier 50 Bilateral procedure appended, as indicated in the CPT® 2014 codebook.Sep 1, 2014
What is the modifier for bilateral procedure?
modifier 50Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).Nov 7, 2014
How do you bill for cerumen removal?
CPT code 69210, Removal impacted cerumen, (separate procedure) one or both ears.
Can 69210 and 69209 be billed together?
You may not bill CPT code 69209 with CPT code 69210, “removal impacted cerumen requiring instrumentation, unilateral,” for the same ear. However, CPT codes 69209 and 69210 can be billed for the same encounter if impacted cerumen is removed from one ear using instrumentation and from the other ear using lavage.Jun 2, 2016
Can 69210 and 92567 be billed together?
e. 69210 is not to be used for billing of removal of non-impacted cerumen – use an appropriate E&M code instead. 3 g. 69210 is allowed when billed in conjunction with one of the following: 92550, 92552, 92553, 92556, 92567, 92570, 92579, 92582, 92587.Apr 1, 2020
What is the difference between CPT code 69209 and 69210?
Like CPT 69210, (removal of impacted cerumen requiring instrumentation, unilateral) 69209 requires that a physician or qualified healthcare professional make the decision to irrigate/lavage. However, unlike 69210, 69209 allows removal to be carried out by clinical staff.
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Coverage Guidance
Cerumen impaction is a condition in which earwax has become tightly packed in the external ear canal to the point that the canal is blocked. Extraction requiring methods beyond simple irrigation or removal by Q-tip or cotton-tipped applicator may require a physician's skill.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L33945-Cerumen (Earwax) Removal.
ICD-10-CM Codes that Support Medical Necessity
It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM (e.g., to the fourth or fifth digit). The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
