You Be the Coder:
Payment for E/M + 69210 Is Possible, If You Meet Reqs
Published on Tue Feb 28, 2012
Question: When we bill an impacted cerumen removal (69210) with an office visit (99201-99215), the insurance company bundles it. We have tried attaching modifier 25 to the E/M code. Should we attach a different modifier to 69210?Alabama SubscriberAnswer: First of all, look back at your physician notes. You need to know how he's performing the removal of the impacted cerumen. If the ENT is only doing an ear wash and it does not require a) substantial physician skill and b) the use of instruments such as currettes, etc., you cannot bill 69210 (Removal impacted cerumen [separate procedure], 1 or both ears). If the ENT's notes do not meet the above definition, you should consider the service included in the office E/M service (99201-99215, Office or other outpatient visit ...).The only time you'll receive separate payment for both an E/M visit in addition to the removal of impacted cerumen is if the E/M [...]
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