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69210 all of a sudden being denied as global?

K

kacampbell411@hotmail.com

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1
Hello,

I am a pediatric biller, for years we have been removing ear wax at the same time as seeing patients for other symptoms.
For years we have been paid for both an E&M code as well as the 69210 code. I always make sure the E&M code has a different and separate dx code attached than the impacted cerumen code and it's always been paid. However recently I am having carriers deny the 69210 as global to the 99213 even though I use a modifier on 99213 and both codes have totally different dx codes attached. Anyone else having this issue recently?
 
kacampbell411@hotmail.com said:
Hello,

I am a pediatric biller, for years we have been removing ear wax at the same time as seeing patients for other symptoms.
For years we have been paid for both an E&M code as well as the 69210 code. I always make sure the E&M code has a different and separate dx code attached than the impacted cerumen code and it's always been paid. However recently I am having carriers deny the 69210 as global to the 99213 even though I use a modifier on 99213 and both codes have totally different dx codes attached. Anyone else having this issue recently?
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HELLO,

WELCOME TO THE CLUB. I WORK WITH ENT HERE IN TEXAS. 69210 IS ALOT OF WHAT WE DO. WELL THE INSURANCES GIVING ME A PAPER HEADACHE. AETNA HAS STARTED DENIING THE 69210 WITH E/M SERVICE WITH MODIFIER 25. EVEN CIGNA IS GOING TO START DENYING E/M WITH MODIFIER 25 BECAUSE THEY FEEL MODIFIER 25 IS BEING ABUSED SO THEY ARE DENING 69210 FOR STARTERS, CIGNA COME JUNE WILL REQUIRE THE MEDICAL RECORDS ON EVERY CLAIM THAT IS SUBMITTED WITH MODIFIER 25. FOR AETNA I AM HAVING TO APPEAL THE CLAIM DENIED. HAVING A GREAT TIME. LOL. I HAVE HEARD THRU THIS FORUM THAT IT IS HAPPENING ALL OVER THE STATES.
 
kcowan said:
HELLO,

WELCOME TO THE CLUB. I WORK WITH ENT HERE IN TEXAS. 69210 IS ALOT OF WHAT WE DO. WELL THE INSURANCES GIVING ME A PAPER HEADACHE. AETNA HAS STARTED DENIING THE 69210 WITH E/M SERVICE WITH MODIFIER 25. EVEN CIGNA IS GOING TO START DENYING E/M WITH MODIFIER 25 BECAUSE THEY FEEL MODIFIER 25 IS BEING ABUSED SO THEY ARE DENING 69210 FOR STARTERS, CIGNA COME JUNE WILL REQUIRE THE MEDICAL RECORDS ON EVERY CLAIM THAT IS SUBMITTED WITH MODIFIER 25. FOR AETNA I AM HAVING TO APPEAL THE CLAIM DENIED. HAVING A GREAT TIME. LOL. I HAVE HEARD THRU THIS FORUM THAT IT IS HAPPENING ALL OVER THE STATES.
Click to expand...
Hi!

quick question....since your appeals, have you seen payments?

I work for a large multispecialty/hospital group in NJ and I'm seeing alot of these denied for bundling by aetna.

Thanks!
 
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