Wiki Another Wax Removal Question...

[Katie22c]

I have seen this a few times in the search of this forum, but having a hard time really confirming the entire thought process with any supporting articles.

If an ENT clinic has patients regularly scheduled for ear check up for cleanings, but when the patient comes in they have no other complaints, nor do they even have actual impacted wax, maybe just some normal wax removal. This scenario would translate to an E&M only, which is now based on time or MDM. And since ear wax is a normal state, and thus has no actual dx, that "Z01.10 - Encounter for examination of ears and hearing without abnormal findings" would be sufficient to support the E&M. Does this train of thought carry weight? What do you all do in this situation?

Any additional advice for an impaction removal only that takes extended amount of time? It seems unfair that the provider would not be able to get more credit for their time in that scenario when 69210 is a lower RVU then 99212 but they both could take 20-30 minutes of time.

 

[b.cobuzzi]

When the patient calls to schedule a “routine” ear check they should be asked if they are having any problems hearing or have any other ear complaints. In all probability, if the patient does not have impacted wax and only has a normal ear, the patient does not need to come into the office for the check, and the ear check can be delayed by a few months. Insurance companies are not going to pay for care that has no medical necessity. Even when an insurance company pays for preventative services, they limit the frequency which the PM services can be billed. Your provider should not be seeing patients who do not have a complaint, who do not have some sign or symptom unless they are providing PM care, but ENTs do not provide PM care. PM care is part of primary care and gynecology.