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ED Coding and Reimbursement Alert

Reader Questions:

Include modifier to reflect 'partial' removals

Published on Sat Nov 06, 2010

Question: Documentation states that the physician personally removed a small portion of impacted cerumen with a curette. However, she could not remove the rest of the cerumen because it was too hard. The guideline states she should document how much time and the resources used to remove the cerumen. Should we code 69210 with modifier 52, or just roll the work into an ED E/M service?Connecticut SubscriberAnswer: Code the impacted cerumen removal (69210, Removal impacted cerumen [separate procedure], one or both ears) and consider appending the modifier 52 (Reduced services).Why not 53? Modifier 53 (Discontinued procedure) is for procedures that were halted due to a concern regarding a complication of patient problem. Use this guide when deciding between modifiers 52 and 53:Use 53 when: Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of [...]
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