Wiki Modifier for 69210

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Kimberlygraham

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A pt comes in for recert to hh. And was given immunization 99214-25
also has ear's irrigated - ( 2 units) (both ears) - 69210 do i add a 59 modifier? To this cpt?
 
My opinion

Hi,

As per my opinion, if the patient is specifically coming for immunization and at the same time gets removal of impacted cerumen, then E&M code shouldn't be billed, as Dx plays an imperative role here.

It should be coded this way:

No 59 modifier required.

69210-RT (Impacted Cerumen, Right Ear)
69210-LT (Impacted Cerumen, Left Ear)
90471 (appropriate ICD in accordance to LCD of payer)

In case, the patient comes with knee pain and gets immunization booster along with removal of impacted cerumen from bilateral ears using instrumentation. Then, it needs to be coded this way:

No 59 modifier required.

99214-25 (Knee pain)
69210-RT (Impacted Cerumen, Right Ear)
69210-LT (Impacted Cerumen, Left Ear)
90471 (appropriate ICD in accordance to LCD of payer)

Hope it helps....:)

Thank you,
Rajinder Singh Dhammi, CPC
 
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A modifier 59 is not required since there are no other incidental procedures with 69210 (99214 is not considered a procedure and the immunization is not considered a part of the irrigation) - modifier 25 on the E&M code should be sufficient assuming it is supported by documentation.

I'd point out though that given your description, 69210 is not correct - that code is for removal of impacted cerumen with instrumentation, such as a curette. For removal by irrigation, 69209 is the correct code. 69209 may be billed with modifier 50 if the procedure was done for both ears.
 
I agree with you Thomas

Very correct.........I agree with you Thomas.

Thank you,
Rajinder Singh Dhammi, CPC
 
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