Impacted Ear Wax - Ear Lavage

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8
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I have been receiving a bunch of denials on ear lavages. I have heard both ways that we can charge for an ear lavage or that it is included with the ov. Has anyone been able to get any ins companys to pay for an ear lavage? We have tried filing with the mod. 25 on the ov visit but that does not change the outcome. We still are receiving denials.
Any advice is welcomed. Thanks!
 
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165
Location
San Diego
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Hi,

I've billed cpt 69210 for impacted ear wax along with an e/m code and modifier 25 with no problems. What do the denials say? Are they specific to a certain payor? My doctor is contracted with an HMO that does not allow billing of a visit/with modifier 25 & a procedure code on the same dos. There is no appeal allowed, no nothing....it's actually part of the contract that states that a visit and same dos procedure will not be reimbursed separately. Do you think that's the case?
 

Cottrell

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103
Location
north seattle wa
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ear was removal

There is a medical review policy for 69210.
It states:
Indidcations and limitations of coverage: Generally, simple cerumen removal is considered part of the office visit and should not be separately billed to Medicare. Exceptions to this would be considered only if a significant amount of physician effort is required to visualize the typmanic membranes to evaluate a specific condition related to the ears, Such conditions include: otalgia, toitis media, otits externa, dizziness, vertigo, hearing loss and conditions relating tothe typmanic membrane or auditory ossicles.
Covered ICD-9 code is 380.4 Impacted cerumen

It may be your dx code.
Hope this helps.

Wendy
 
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We have been using the code 380.4 to file but has not followed with any other code.
I will need to go back and see which ones can be coded with the addtional dx that you mentioned. I will give that a try and see if they will pay out for the procedure, if not, then our physicians need to just include it in the ov.
Thank you both for your feedback.
 
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