Otolaryngology Coding Alert

Question: When a Medicare patient presents to our office with a chief complaint of "hearing loss" and a cerumen impaction, the otolaryngologist removes the impaction under microscopic visualization. To detect any potential middle-ear contributions, the physician orders in-office tympanometry. I billed these services as 9921x, 69210, and 92567. Medicare, however, rejects 9921x and 69210, stating "payment adjusted because this procedure/ service is not paid separately." How should I submit charges for these services? Ohio Subscriber Answer: Depending on the impaction specifics of each case, you should file these claims using a different cerumen removal code. You can also combat denials with modifier 25 on the office visit code and separate E/M and test diagnoses. To receive payment for a same-day cerumen removal and audiological test (such as 92567, Tympanometry [impedance testing]), you will have to report G0268 (Removal of impacted cerumen [one or both ears] by physician on same date [...]