audiologic Function Tests + 69210 and G0268


True Blue
Everett, WA
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I've already searched the forums and have gleaned some good information. Can someone take a look at this coding and verify that the 69210 will always be bundled with these codes when performed on the same day.

92567 (modifier 51 is not used by this insurance company)
69210-59 <---this is what was submitted which I am also questionaing

This is for a commercial carrier and due to 69210 = a separate procedure and tha fact that the CCI edits also bundle the cerumen removal to 92557 and 92567, I'm thinking we may already have the answer? And I do know it would be improper to use modifier 59 to override the edits. Would someone kindly validate my thinking?

Additionally, when would G0268 come into play? Could this code be used IN ADDITION to the 92557 and 92567 done on the same day by the same doctor, especially if the insurance company accepts it? And to anyone's knowledge would it indeed generate payment for the 69210?

Hope this submission stirs a response from the folks who travel this forum.

Suzanne E. Byrum CPC


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Hi, Suzanne,
In our practice, we bill the E/M with 25 modifier, auditory testing and G0268 together and do receive reimbursement. It is helpful if there is a different diagnosis available as primary for the E/M visit and then code the G0268 with cerumen impaction. A 69210-59 will generally not pay if there is auditory testing even with the modifier. But, the G codes specifically allows for cerumen removal with auditory testing. Hope this helps.

Lori M. Isner, CMA, CPC