ED Coding and Reimbursement Alert

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 [...]