69209 requires verbage in documentation per medicare

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3
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Columbia City, IN
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I need help with 69209 documentation requirements to bill this...I was told Medicare requires the doumentation specifically state "impacted" "impaction"...does it actually have to have this word in the documentation to be billable or get paid or can it say "wax buildup" and so forth? Please advise.:confused:
 

keishamarie

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17
Location
Austin, TX
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69209 Medicare denial for no referr phys

The treating Doc is always the one that performs the procedure on the impacted cerumen, and I was told today by Medicare that a referring Doc is required for this procedure. So we keep getting denials because there is NO referring Doc. Only the treating Doc at our Urgent Care Facility. Any help on this?
 

keishamarie

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17
Location
Austin, TX
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Yes you were told right

Yes I was told by a medicare rep that for instance if the Pt came in for hearing loss, or ear pain and the Doc found cerumen impaction that the removal code would be covered. If there was NO impaction found on exam, the cerumen removal code was not justified and would not be paid. Hope this helps!!



I need help with 69209 documentation requirements to bill this...I was told Medicare requires the doumentation specifically state "impacted" "impaction"...does it actually have to have this word in the documentation to be billable or get paid or can it say "wax buildup" and so forth? Please advise.:confused:
 

keishamarie

Contributor
Messages
17
Location
Austin, TX
Best answers
0
Yes you were told right

Yes I was told by a medicare rep that for instance if the Pt came in for hearing loss, or ear pain and the Doc found cerumen impaction that the removal code would be covered. If there was NO impaction found on exam, the cerumen removal code was not justified and would not be paid. Hope this helps!!



I need help with 69209 documentation requirements to bill this...I was told Medicare requires the doumentation specifically state "impacted" "impaction"...does it actually have to have this word in the documentation to be billable or get paid or can it say "wax buildup" and so forth? Please advise.:confused:
 
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