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Cerumen Removal Unsuccessful

  1. #1
    Location
    Overland Park, KS
    Posts
    1,166
    Default Cerumen Removal Unsuccessful
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    The NP removed the cerumen with a curette after irrigation from one ear, but it was not removed from the other ear. The provider removed the additional charge for the CPT 69210 because it was only removed from one ear and unsuccessful in the other ear. This patient also had an e/m code for another diagnosis. My questions are:

    I realize that the E/M would be coded with -25, and we should have coded 69210 for the cerumen removal for the one ear, but if was unsuccessful from the other ear, how do we capture that?

    If the patient returned in 3 days and had the cerumen successfully removed via irrigation and curette, could we bill for the cpt code of 69210 again?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Location
    Johnstown, Pennsylvania Chapter
    Posts
    40
    Default
    I know this may seem like a dumb question, but was the cerumen impacted or did they just remove cerumen?

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    It was impacted.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Default
    I think you can bill the E/M and 69210 for the first day, since 69210 says 1 or both ears. Nothing as far as billing would need to be reported for the unsuccessful removal in the other ear that day. Then on the next visit, if it qualifies for 69210, that would be billed alone for the other ear.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Good question-

    I looked at one of my "Pink Sheets" (peds) and they recommended modifier 53 for the unsuccessful attempt. Does make you wonder if the carrier will actually pay for it. (?)

    As for the return visit...if the documentation met the "procedure" requirements, I don't see an issue billing for it again. 69210 has zero global days.

  6. #6
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks so much!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  7. #7
    Default
    Would you use the 53 only if the attempt was made on either ear and couldn't be done at all? You wouldn't use the 53 if you successfully performed in on one ear, right?
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  8. #8
    Location
    North Carolina
    Posts
    3,126
    Default
    You've got my brain on overload now....

    So...69210 is inherently a bilateral procedure (based on it's description). It wouldn't seem logical to be able to bill both since, technically, you can't bill bilaterally...

    99213
    69210 (for the successful procedure)
    69210-53 (for the unsuccessful procedure)

    But...since the description states one or both ears, does the extra work allow for it if documented properly??

    I dont' know....I'm a little torn on this one......

  9. #9
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks to both of you! I really can't see -53 being used for the second removal either.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  10. Default
    CPT 69210 specifically states Removal impacted cerumen (separate procedure), 1 or both ears; before I move on, a word of caution, according to Medicare guidelines, a "skilled physician" must remove impacted cerumen; that being said, if all medical documentation supports an E/M with cerumen impaction removal, you can bill the E/M w/mod 25 and then 69210; you are over-thinking the situation, CPT says one or both ears; as the patient returned in 3 days and there is zero global, bill CPT 69210 again for that encounter. My co-worker and I have this saying when we get hung up on a situation like this, stop splitting hairs; you have everything you need to back up your claims.

    Jennifer
    CT ENT

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