Cerumen diagnosis code

hallansmom

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That makes sense but my one extender thinks she should be able to bill the E/M and 92504 for the removal of it and she wants to use the dx code of impacted even though it isn't.
 
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Clovis, CA
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92504 - Binocular microscopy (separate diagnostic procedure).

This code is not used with minor procedures, or when it is not used for a diagnostic procedure. Cerumen removal and binocular microscopy are bundled with each other.

69209 - Removal impacted cerumen using irrigation/lavage, unilateral
69210 - Removal impacted cerumen requiring instrumenation, unilateral

For bilateral, use modifier 50

If it's not impacted, it's not billed as a procedure.

CPT states, "For cerumen removal that is not impacted, see E/M service code..."

Here is an AAPC article on removing cerumen (click me).

Impaction includes at least one of the following:
1. Cerumen impairs the exam of clinically significant portions of the external auditory canal, tympanic member, or middle ear condition;
2. Extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc.;
3. Obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician skills. (but check for payer policy because some allow you to bill for an MA doing a warm water irrigation)
 

hallansmom

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My extender wants to submit H61.23 when it isn't impacted as the only dx code. What can I give her in place of it? Thank you for all your help.

Also what is your suggestion for code 40806? In Florida, MCD doesn't recognize it as a code and continuously denies it. Any suggestions??
 

mitchellde

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You do not code normal, and you do not assign a code for a condition the documentation does not support. If the cerumen is not impacted then use the symptoms the patient presented.
as far as the 40806 goes, what does the denial state?
 

hallansmom

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The denial code reads, " Denied: Code is not a covered service on your fee schedule". They will not give us any further info as to what code to use in its place. Any thoughts??
 

hallansmom

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You do not code normal, and you do not assign a code for a condition the documentation does not support. If the cerumen is not impacted then use the symptoms the patient presented.
as far as the 40806 goes, what does the denial state?
The denial code reads, " Denied: Code is not a covered service on your fee schedule". They will not give us any further info as to what code to use in its place. Any thoughts??
 
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40806: Incision of labial frenum (frenotomy): The physician makes an incision in the labial frenum, freeing the lip and allower greater range of motion. The labial frenum is the membrane that attaches the lip to the gums.
41010: Incision of lingual frenum (frenotomy): The physician makes an incision in the lingual frenum, freeing the tongue and allower greater range of motion. The lingual frenum is the membrane under the tongue that attaches it to the floor of the mouth.

Both of these codes are considered experimental by alot of medical plans. If it's not a covered service on your fee plan, then... it's not paid on your fee plan.

Some insurances cover them only if there is a complete tongue-tie (Q38.1) or lip-tie (Q38.0), and not a partial one, AND if there has been demonstrated feeding and/or speech problems, not just to prevent problems.
 

b.cobuzzi

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Is the only reason the practitioner looking in the ear with binocular microscopy the wax? Or does the patient have complaints like abnormal hearing perception H93.29x? She/he does not know if there is IMPACTED cerumen until they look into the ear and they need to justify the need for the binocular microscopy in the note.
 
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