5 Quick Tips Help You Collect For Cerumen Removal
Published on Tue Sep 19, 2006
Watch your ICD-9 codes if the physician performs E/M with removal
Payers may seem notoriously difficult when you-re trying to obtain E/M service payment with impacted cerumen removal--but the ICD-9 codes and modifiers you use can make the difference between denial and deserved dollars.
Otolaryngology coders often wonder whether they can report an E/M service when the physician performs impacted cerumen removal at the same visit. Although circumstances and documentation may justify reporting both the service and the procedure, insurers rarely pay both, so you should know when you can report them together, and when the services are bundled.
Try these five strategies, which can help you recoup payment for performed and documented 99201-99215 (Office or other outpatient visit ...) services in addition to 69210 (Removal impacted cerumen [separate procedure], one or both ears). Tip 1: Assign Separate Diagnoses -When looking at the cerumen removal procedure, we must look at what brought the patient to the physician,- says Steven M. Verno, CMBSI, director of reimbursement for Emergency Medical Specialists in Hollywood, Fla. The patient most likely isn't coming in to say, -I-m here to have my cerumen removed.-
Instead, the patient likely presents with complaints of difficulty hearing in one or both ears, possible ear pain associated, and perhaps complaints of a sore throat due to having the eustachian tube involved.
The work involved with examining the patient and determining the appropriate course of action merits two diagnoses: one for the sick visit and the other for impacted cerumen removal.
Otherwise, the insurer will bundle the E/M service into 69210.
Key: The documentation must support both ICD-9 codes. According to most policies, the only appropriate diagnosis to use with 69210 is 380.4 (Impacted cerumen).
The other diagnosis to support the E/M code may represent ear pain (388.7x, Otalgia), otitis media (381-382), or another illness (such as 465.9, Acute upper respiratory infections of multiple or unspecified sites; unspecified site).
Example: A patient complains of ear pain. Impacted cerumen blocks the eardrum, preventing the otolaryngologist from examining the ear. The physician uses an otoscope and curette to remove the impaction. She then examines the ear and diagnoses the patient with acute purulent otitis media.
In this case, you have two diagnoses--382.00 (Acute suppurative otitis media without spontaneous rupture of ear drum) and 380.4 (Impacted cerumen). You should use the otitis media diagnosis (382.00) for the E/M service, and impacted cerumen (380.4) for the procedure.
The different ICD-9 codes help show the insurer that [...]
