Wiki Ear Irrigation

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Radcoder86

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I know this topic has been brought up a lot, but I can't seem to find the info I'm needing. A pt came in and had a physical and the doctor performed an ear irrigation for cerumen impaction. Can I bill the wellness code and then a 99211 w/ a modifier even if the doctor was the one that performed it, not the nurse?
 
If it's documented appropriately you should be able to with a modifier on the E/M code (separately identifiable). A nurse doesn't have to be the one to use 99211. Also, check out code 69210 to see if this meets better criteria.

Hope this helps!

Lena
 
An ear irrigation is not a separately billable item, it is inclusive to the E&M, if performed at a well visit it is part of the wellness visit unless you have sufficient documentation to support a billable level for a patient complaint. If the provider irrigated the ears to be able to get a better look, you cannot charge a separate level. Also 69210 is not to be used for an ear irrigation. So to bill a separate visit level you must have a patient complaint of something relevant to the ear documented, and there must be sufficient key components documented to have a level that is not already included with the wellness.
 
I understand for an irrigation or "ear wash" CPT code 69210 is not applicable; however, I suggested Rad check out the description of the code regardless. Some coders aren't aware that if the cerumen is removed via instrument this code should be utilized as opposed to the E/M.

I believe if the patient brought up the ear complaint and the need for a physical at the TOS, documentation supports E/M CPT 992__ (irrigated, no instrument), then this may be billed with modifier 25 in addition to the physical.

Lena
 
You would bill the wellness code, not 99211, with a 25 modifier on it. The removal code depends on what kind of removal it was. 69210 is done with a cerumen spoon (looks like a long stick), 69209 is done by irrigation. I've found that 69209 gets less reimbursement. You can not bill both 69209 and 69210. If you do both ears, add a 50 modifier to the removal code and charge 2x for quantity.
 
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