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ED Coding and Reimbursement Alert

Readers Question:

Bilateral Earwax = Single Code

Published on Wed Jan 27, 2010

Question: A patient reports to the ED complaining of pain in both her ears and a massive headache; further questioning reveals that both ears "itch, hurt bad, and are turning red." The patient remarks that she feels "almost deaf" and is paranoid that people are talking about her.

Notes indicate a level-three E/M service, during which the physician diagnoses impacted cerumen after otoscope examination in both ears. Using a scalpel and irrigation, the physician removes impacted cerumen from both ears. Should I report 69210 x 2 or 69210 with modifier 50 for the removals?

Nevada Subscriber

Answer: Neither. On the claim, report the following:

• 69210 (Removal, impacted cerumen, one or both ears) for the cerumen removal;

• 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) for the E/M;

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99283 to show that the procedure and E/M were separate services; and

• 380.4 (Impacted cerumen) appended to 69210 and 99283 to represent the patient's cerumen.

Explanation: The 69210 descriptor states that the code is for one or both ears, so report this code just once for the procedure.

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