Can I submit CPT code 69210 with CPT modifier 50?
Do not submit CPT modifier 50 or multiple units. Claims submitted for CPT code 69210 with CPT modifier 50 will be returned as unprocessable (remark code MA130) and must be corrected and resubmitted as new claims. If the CMS MPFSDB is updated and this information changes, CGS will notify providers through our e-mail list.
What is the NCCI code 69210?
The National Correct Coding Initiative (NCCI) bundles 69210 to audiology testing codes with the assumption that clearing earwax/impacted cerumen is a precondition to the testing (see: Federal Register, December 31, 2002, pages 80011–80012). Check the NCCI edits before reporting 69210 in addition to diagnostic testing.
Is the E/M code 69210 correct?
In this case, the correct E/M code would be a 99212 (or higher if indicated by medical necessity and documented appropriately), but it would not be appropriate to use code 69210 unless the procedure required physician work.
Is 69210 a good CPT code for cerumen removal?
Cerumen removal reporting done right. Some CPT® codes cause more than their share of confusion, and judging from the feedback we receive from Healthcare Business Monthly readers, one such code is 69210 Removal impacted cerumen requiring instrumentation, unilateral. Here’s the information you need to clear the confusion.
Does CPT code 69210 need a modifier?
A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice.
What modifier should be used with 69210?
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).
Can modifier 50 be used with 69210?
Additionally, the descriptor of 69210 has been clarified to reflect that the code is inherently unilateral. For bilateral impacted cerumen removal, report code 69210 with modifier 50, Bilateral Procedure, appended.
How do I bill 69210 to Medicare?
Reporting 69210 Documentation should indicate the equipment used to provide the service. CPT® considers this procedure unilateral and states, “For bilateral procedure, report 69210 with modifier 50.” Contradictory to CPT®, Medicare considers this a bilateral procedure and prices it as such.
Can modifier 50 be used with 69209?
Unilateral Procedure The descriptors for codes 69209 & 69210 indicate that they are unilateral codes. For bilateral impacted cerumen removal, report these codes with modifier 50, Bilateral Procedure, appended. Note: Medicare does not allow the use of modifier 50 for impacted cerumen removal.
Can 69210 be billed with 2 units?
This means that for Medicare payers, the relative value units assigned to 69210 “are already based on the procedure being performed as a bilateral procedure.” In contrast to CPT® instructions, the Centers for Medicare & Medicaid Services (CMS) allows only one unit of 69210 to be billed when furnished bilaterally.
How do you bill for cerumen removal?
Method Determines Coding for Impacted Cerumen Removal For removal by lavage, the correct code is 69209 Removal impacted cerumen using irrigation/lavage, unilateral. For removal using instrumentation (e.g., forceps, curette, etc.), turn instead to 69210 Removal impacted cerumen requiring instrumentation, unilateral.
How Much Does Medicare pay for cerumen removal?
According to the Medicare physician fee schedule for 2020, the guide for what doctors may bill to original Medicare for their services, if approved, Medicare pays between $35 and $60 dollars for earwax removal.
Does 69209 need a modifier a 59?
If documentation indicates that the patient had cerumen impaction and the removal required physician work and instrumentation such as wax curettes, forceps and/or suction rather than simple lavage (69209), modifier -59 may be appended to procedure 69210 to provide separate payment when an E/M code is billed by the same ...
What is a 50 modifier?
Use 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).
What is the difference between 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.
Can 69209 and 69210 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.
Q.What Is The Correct Use of Cpt Code 69210 (Removal Impacted Cerumen [Separate Procedure], One Or Both ears)?
– Question submitted by Kathy Partenheimer, Medical of DuboisA.In the July 2005 issue of CPT Assistant, the AMA clearly indicates that you should r...
Q.How Does One Determine That The Cerumen Is Actually Impacted So That Code 69210 May Be Used For Removal of The Cerumen?
A.For the purpose of accurate coding, the AMA defines “impacted cerumen” in the July 2005 CPT Assistant as follows:If any one or more of the follow...
Q.If The Physician Removes Cerumen as Part of The Exam but The Cerumen Is Not Impacted, What Code Would Be Appropriate?
A.A simplistic answer is that removing the wax is simply included in the emergency and management (E/M) code. The actual situation, however, is not...
Q.What Are The Appropriate ICD-9 Diagnosis Codes to Justify Billing For 69210?
A.Medicare accepts many different ICD-9 codes as “supporting medical necessity.” By definition, however,69210 always involves the diagnosis of impa...
Can E&M be billed for removal of cerumen?
As per my opinion, if the patient is specifically coming for immunization and at the same time gets removal of impacted cerumen, then E&M code shouldn't be billed, as Dx plays an imperative role here.
Is modifier 59 required for 69210?
A modifier 59 is not required since there are no other incidental procedures with 69210 (99214 is not considered a procedure and the immunization is not considered a part of the irrigation) - modifier 25 on the E&M code should be sufficient assuming it is supported by documentation.
What is the ICD-9 code for impacted cerumen?
A.Medicare accepts many different ICD-9 codes as “supporting medical necessity.” By definition, however,#N#69210 always involves the diagnosis of impacted cerumen, so it seems reasonable to always attach the code for impacted cerumen ( 380.4) to the code 69210.#N#Of course, the physician documentation should clearly demonstrate the presence of impacted cerumen, as defined above. If you are attempting to code an E/M code in addition to code 69210, appropriate coding of an additional diagnosis is often helpful to reduce denials.#N#DAVID STERN, MD ( Practice Velocity)
What is the code for cerumen removal?
Rather, most coders would recommend that code 69210 be reserved for use in situations where the cerumen removal takes significant effort by the physician. This is a situation where many individual payors have set different policies for application of this code, so it is best to check with individual payors for their policy.
Is wax removal included in E/M?
A.A simplistic answer is that removing the wax is simply included in the emergency and management (E/M) code . The actual situation, however, is not quite so straightforward.
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.
What is CPT code 69210?
CPT also defines CPT code 69210 as a “unilateral” procedure that should be reported using a -50 modifier (bilateral procedure) if performed on both ears. Seems pretty straightforward, doesn’t it* Well, “hear” is the issue.
What is scenario 3 of 69210?
Scenario 3, however, would be reported with code 69210 because both criteria were met: the patient had cerumen impaction and the removal required physician work using an otoscope or other magnification and instrumentation, rather than simple lavage. When removal of impacted cerumen is not covered.
Does Medicare accept CPT code 69210?
The Centers for Medicare and Medicaid (CMS) published information in the 2014 OPPS Final Rule indicating that they will not accept CPT code 69210 with a -50 modifier. Medicare reimbursement for 69210 will only be made for one unit of service, regardless of whether one or two ears are involved.
Can you get reimbursement for cerumen removal?
Generally, the simple/routine removal of cerumen (e.g., softening drops, use of cotton swabs and/ or cerumen spoons) is considered a part of the office visit and therefore cannot be separately reimbursed on the same day as an Evaluation and Management (E&M) service. When removal of impacted cerumen is covered.