69210 incidental under anesthesia

[misbell]

Group-

Our Senior coder is telling one of our collectors to append -59 modifier to the cerumen during a T&A surgery. Insurance already denied because, as I also think, removal is incidental because it is simple procedure that usually does not require anesthesia. AND, since it is being done as an after-thought while under anesthesia, I can see where ANY insurance would deny....But, our company is looking at adjustments carefully and the collectors are still being told to append the -59....HELP????

 

[dimmitta]

What help are you needing? There are no CCI edits in place that would bundle a cerumen removal with a T&A surgery. Not sure a 59 modifier should be necessary. If the procedure was done and the doctor says it was medically necessary then it should be billed and I would fight the denial.

While 69210 does not usually require anesthesia, there are times when it is needed. For example, when the child is too young to sit still enough for it to be done in office. Also, just because this is a "simple procedure", that shouldn't negate it from being reimbursed.

Every company is looking at the bottom line these days and that does make our job more stressful. Not sure if that helps but...good luck!