Wiki Billing 69210 Cerumen Removal Bilateral

[brownharrisfam03@gmail.com]

How should bilateral 69210 be billed? We have had denials from NGS Medicare by billing 69210-50 and also billed 2 seperate lines 69210-RT & 69210-LT. I'm aware the code has changed to unilateral but how should bilateral 69210 be billed?

 

[TiffianyEdwards]

new guidelines

That code has been changed .. the new cpt code description is one or both ears. You don't need a modifer 50. But the catch is the documentation has to state that they used a tool to remove the wax, it can no longer be billed for just irrigation. I had a very hard time with this one when I started coding urgent care.

Here is a recent article that I used as education to my providers

http://blogs.aafp.org/fpm/gettingpaid/tags/cpt

 

[RebeccaCross*]

Medicare does not recognize the 2014 CPT update. They have cited this guidance in the Federal Register.

 

[TiffianyEdwards]

update

Here is the direct quote from the federal register : However even though they don't recognize the cpt update you can still only bill one unit, and it must include using a tool as stated in my previous post.

14) Cerumen Removal (CPT Code 69210)

This code was reviewed as a potentially misvalued code pursuant to the CMS high expenditure screen. The CPT Editorial Panel changed the code descriptor for removal of impacted cerumen from ?1 or both ears? to ?unilateral,? effective January 1, 2014. The AMA RUC recommended a work RVU for this code of 0.58. In its recommendation to the AMA RUC, the specialty society stated that there wasno information to determine how often the service was performed unilaterally but asserted, and the AMA RUC agreed, that the service was performed bilaterally 10 percent of the time. In determining its recommendation, the AMA RUC applied work neutrality to the current work RVU of 0.61 to arrive at the recommended work RVU of 0.58 based upon the assertion that the code that was previously only reported once if furnished bilaterally, would now be reported for two units, due the descriptor change.
We disagree with the assumption by the AMA RUC that the procedure will be furnished in both ears only 10 percent of the time as the physiologic processes that create cerumen impaction likely would affect both ears. Given this, we will continue to allow only one unit of CPT 69210 to be billed when furnished bilaterally. We do not believe the AMA RUC's recommended value reflects this and therefore, we will maintain the CY 2013 work value of 0.61 for CPT code 69210 when the service is furnishe