You may NOT upcode an office visit to "make up" for a procedure that is not being reimbursed. You may up code only when the docuemntation by the physician meets the criteria for counseling or coordination of care and time spent by the physician is documented. So every time you follow this directive by your office manager you are doing something wrong! You need to investigate why these procedures are not reimbursing. Impacted cerumen removal is reimbursed if it is performed by the physician and involves the use of a scoop or currette, this is NOT an ear irrigation, and the physician must write a procedure note. Then you put the 25 modifier on the E&M and if it is not paid you appeal. The aerosol should be paid with an office visit if you use the 25, what does the denial state?
Debra Mitchell, MSPH, CPC-H
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