Question regarding Cerumen impaction

clmoreland

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In a previous company that I worked for we were told that Medicare would not pay for the cerumen impaction removal with an EM visit if this were the only issue being addressed. I was told by sing the 69210 along with a visit EM with modifier 25 Medicare could in an audit retract that payment. Am I correct in being told this or does anyone know of any place there is documentation or guidelines for the payment of the ear irrigation along with a visit EM? You can email any answers to moreland@msaphy.com as I don't get to check the forum discussions much during the day. Thanks in advance!
 

Austgen

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Cerumen removal

Look at the HCPCS code G0268 and see if this works for you. Good luck.
 

JamieFear

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G0268 is for removal of impacted cerumen(one of both ears) by physician on same date of service as audiologic funtion testing. So would you need to be for the audiologic function testing also (if it was performed)? I am not sure what all is involved in the audiologic function testing.
 
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Ear irrigation is NOT removal of impacted cerumen

You mention "ear irrigation." This is NOT the same as removal of impacted cerumen, CPT 69210. Be sure you are correctly coding what was performed.

F Tessa Bartels, CPC, CEMC
 

clmoreland

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RE Cermumen impaction

Sorry I did mean to say removal of impaction. Typo! So do you know if medicare denies claims where there is an visit code for example 99213, 69210 along with diagnosis 380.4 and appending the 25 modifier and there is nothing else that is addressed in the visit?
 

mitchellde

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I do feel the denial is due to so many times on audit the payers (Medicare included) have discovered that the procedure is not being performed, that is it is an ear irrigation or it is performed by the nursing staff, that they just have the edit to deny one or the other, the ov or the procedure. I have always won this on appeal with the documentation to show the physician did have the parameters of the 25 modifier met and he did perform an impaction removal with a procedure note.
 
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