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ED Coding and Reimbursement Alert

Eye Claims for Cerumen Removal … and a Possible $30 Boost

Published on Fri Oct 01, 2010

Earwax treatment always equals E/M ... but sometimes it warrants a procedure, too. Listen up, coders: Patients reporting to the ED for removal of earwax exist on the fault line between ED E/M service and procedure code. Knowing the difference could net you about $30 more per claim. Check out these clues for help making the decision between a procedure code and an E/M on your earwax encounters. Choose E/M If Procedure Isn't a Clinical 'Removal' It might seem like a slam dunk: Patient reports to the ED with earwax, provider removes it, and coder chooses cerumen removal code ... right? Wrong: Some earwax extraction encounters will not reach the procedure level. In order to report a cerumen removal code, the provider has to use direct visualization (via otoscope) to remove impacted cerumen, says Sandra Pinckney, CPC, coder at Certified Emergency Medicine Specialists PC in Grand Rapids, Mich. The methods [...]
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