E & M Coding with Ear Lavage

nstauffer

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I am having a hard time getting insurance companies to pay an E&M code and an ear lavage when they are done on the same day. I do attach modifier 25 to the E&M code. Any suggestions?
 

Chelle-Lynn

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Many insurance companies will not pay on an E&M and ear lavage on the same day as they do not consider the removal of ear wax by lavage only to be significantly separate from a standard E&M. It is the old adage that just because there is a code does not make it payable. :)

If you are billing with a modifier 25 when appropriate and have submitted records, it may be that their internal guidelines will not allow for it. 69210 is considered separate enough due to the use of instrumentation, by lavage only as 69209 is often considered inclusive regardless of the modifier 25.
 

CodingKing

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The payer I last worked for did not pay for instrumentation impact either. Since Lavage is lower RVU, we don't pay for either on same date as E&M. You may also want to check to see if the payer has a payment policy. For instance ours had it in the E&M policy.
 
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