Wiki Denial: CPT 99210 Cerumen Removal XU

[zamorahannah02@gmail.com]

Hello, I had a claim denied stating that a modifier was either invalid, incorrect, or missing. For the cerumen removal performed with a curette, I billed 99350, 24, and 69210, XU.

Could you please advise if another modifier should be applied?

Thank you!

 

[sls314]

Hello, I had a claim denied stating that a modifier was either invalid, incorrect, or missing. For the cerumen removal performed with a curette, I billed 99350, 24, and 69210, XU.

Could you please advise if another modifier should be applied?

Thank you!

Can you explain why the Modifier 24 was used? Is the patient in the global period for a previous surgery? Modifier 24 is Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period

69210 is the primary code in the NCCI edit pair and would not need a modifier.

If the evaluation and management service is significant and separately identifiable from the cerumen removal, a modifier can be used to override the relationship.

Modifier 25 is for Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service

 

[zamorahannah02@gmail.com]

Can you explain why the Modifier 24 was used? Is the patient in the global period for a previous surgery? Modifier 24 is Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period

69210 is the primary code in the NCCI edit pair and would not need a modifier.

If the evaluation and management service is significant and separately identifiable from the cerumen removal, a modifier can be used to override the relationship.

Modifier 25 is for Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service

Our NP advised that modifier 24 be applied because the E/M is for the chronic disease management CC. Would modifier 25 be more suitable?

Also, is it acceptable to bill 2 units of 69210 since the impacted cerumen is bilateral?

Really appreciate your assistance!