Wiki Cpt 69210

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nancyk5950

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Hi

Can someone please tell me if Medicare has a site that I can go to and find out the definition of CPT 69210. I am assuming that Medicare still requires this to be done by Physician or NP/PA using otoscope and curette and must be total occlusion.

I need to get documentation that supports this from Medicare some physicians are under the impression that the above is not required by Medicare.

Any guidance on this would be much appreciated.

Thanks
nancy
 
Last edited:
69210

If you have a diagnosis of impacted cerumen 380.4 and it is the only thing being done, you can bill code 69210. Remember this code is for one or both ears, so DON'T use modifier RT, LT or 50.
You would document the procedure in the medical record.
If the patient is being evaluated or seen for other conditions not related to the ear on the same day, you can still code an office visit with a 25 modifier. Hope this helps.
 
69210 - Medicare Ruling

Hi.

I wanted to give you the information I have obtained. I attended a bi-lateral webinar from Noviatas and questioned them directly on why they were not honoring the AMA changes to this CPT effective 2014. This is the link and information of Medicare decision on this code.
Hope this helps.

https://www.federalregister.gov/art...he-physician-fee-schedule-clinical-laboratory

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 405, 410, 411, 414, 423, and 425
[CMS-1600-FC]
RIN 0938-AR56
Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule,
Clinical Laboratory Fee Schedule & Other Revisions to Part B for CY 2014.

(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 was no
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 furnished.
 
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