Cerumen Removal with E&M

cgneff72

Contributor
Messages
18
Location
Indianapolis
Best answers
0
Recently, all of our claims for cerumen removal (69210) are being denied by one of our Medicaid plans with the following:
"The procedure code 69210 is designated as a separate procedure and should not be reported in addition to the code for the total procedure or service of which it is considered an integral component. The complicating factor with this procedure is the fact that many times removal of impacted cerumen is required in order to visualize the ear canal and assess the patient's condition. In these cases, it is considered part of the primary service and not separately reimbursed."

While I understand what they are trying to say, am I to assume that the only time it would be payable is if it is the only service on the claim??

We added modifier 25 to the E&M, but they are not paying on 69210 at all. Has anyone else experienced this?
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
You will have to appeal with notes showing the provider performed this using a scoop or currette, not an irrigation, and it was therapeutic not for better visualization.
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
If it was in fact for better visualization then it is included in the E&M, but it is not always that it has to be a stand alone procedure. If it is for therapeutic benefit to the patient and documentation can support that it can be billed with an office visit and both can be paid. Without looking at your documentation I cannot advise.
 

ksd

Networker
Messages
73
Location
Sparta, MI
Best answers
0
I code ER and Urgent Care charts for varying physicians in multiple states and regardless of the method or reasoning for cerumen removal Medicaid never pays. This is just my experience.
 
Last edited:
Top