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69210 cerumen impaction removal

  1. #1
    Default 69210 cerumen impaction removal
    Medical Coding Books
    Has anyone else heard that we can start billing 69210 with a 50 modifier as of 1/1/2014?

  2. #2
    Yes, Please review 2014 CPT Book page 384, left side at the bottom, See Parenthetical Notation:
    "(For bilateral procedure, report 69210 with modifier 50)"

  3. #3
    Nashville AAPC Chapter
    There are several changes to the 69210 CPT code. One is that it is now unilateral, and second the description is very specific to using instrumentation.

    CPT Description:
    Removal impacted cerumen requiring instrumentation, unilateral

    Lay Description:
    Under direct visualization, the physician removes impacted cerumen (ear wax) using a cerumen spoon or delicate forceps. If no infection is present, the ear canal may be irrigated.

    Coding Tips:
    This code has been revised for 2014 in the official CPT description. Report this procedure for removal of cerumen impaction. It should not be reported for simple irrigation. This separate procedure by definition is usually a component of a more complex service and is not identified separately. When performed alone or with other unrelated procedures/services it may be reported. If performed alone, list the code; if performed with other procedures/services, list the code and append modifier 59.

    This is a unilateral procedure. If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code while others require identification of the service only once with modifier 50 appended. Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image).Code 69210 should not be reported for removal of PE tubes.

  4. Default 69210

    While the code changed to allow a -50 modifier per AMA\CPT, the MUE for this code has not been updated on the RBRVS to "2", nor has the Modifiers "allowed" been changed to include "-50".

    Additionally, G0268 has not had it's description changed to reflect the change.



  5. Default 69210
    I placed a call to Medicare (IL). They have had to move this up the ladder to a 3rd level tier. The issue is not resolved and will take 30-45 for them to "review" the issue. I have been told to keep billing it correctly with the 50 as they may "figure it out" before they resolve my issue and will fix all the denied claims. Hopefully this will help us all out
    Last edited by jkrusely; 01-17-2014 at 01:07 PM.

  6. #6
    Nashville AAPC Chapter
    Default 69210 and Medicare
    Just sharing new information I discovered that all may not be aware of. Medicare will only pay for one unit of the 69210, ever.

    Here?s what Medicare had to say in the Federal Register:

    ?We disagree with the assumption by the AMA RUC that the procedure will be
    furnished in both ears only 10 percent of the time as the physiologic processes
    that create cerumen impaction likely would affect both ears. Given this, we will
    continue to allow only one unit of CPT 69210 to be billed when furnished
    bilaterally. We do not believe the AMA RUC?s recommended value reflects this
    and therefore, we will maintain the CY 2013 work value of 0.61 for CPT code
    69210 when the service is furnished.?

  7. Default
    We have had all our charges for this code deny since the first of the year when we added the modifier 50. My computer locks up everytime I try to pull up the federal register to search for info regarding this code. Can you provide a link to the information you just posted, OCD_coder? Trying to get some solid information that I can share with my doctors...any help would be appreciated. Thank you!

  8. #8
    North Carolina

  9. Default Commercial Payer Denials?
    Thank you everyone for your comments on Medicare.

    I am wondering if anyone is getting any denials from the commercial carriers as well when billing 69210 with the 50 modifier for 2014?

    Jennifer M. Connell, BA, CPC, CENTC

  10. Default
    Yes, we are getting denials from everyone!

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