cgneff72
Contributor
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?
"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?