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Thread: E/M code with cerumen removal

  1. #1

    Question E/M code with cerumen removal

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    We had a patient come in complaining of ear ploblems. The doctor did an examination and said that this patient has eustachian tube dysfunction. He also removed impacted cerumen. Can he charge for an office visit and cerumen removal when the patients primary problem had to do with his ears?

  2. #2

    Default

    Yes you can. You already had an exam (I am of course assuming you did being he looked in their ears) and the cerumen impaction was not the only thing going on.

  3. #3
    Join Date
    Apr 2007
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    Default Cerumen impaction

    Yes you can charge for both but you need a modifier 25 on office visit or insurances won't pay for both. Hope that helps!:d

  4. #4
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    Default

    Quote Originally Posted by Kellyj0h View Post
    We had a patient come in complaining of ear ploblems. The doctor did an examination and said that this patient has eustachian tube dysfunction. He also removed impacted cerumen. Can he charge for an office visit and cerumen removal when the patients primary problem had to do with his ears?
    Just make sure your cerumen removal fits the criteria for billing. I see some providers use this term loosely and upon review of the documentation, the "impacted cerumen" did not warrant separate reimbursement due to the method of removal nor did it meet the clinical requirements for reimbursement.

  5. #5

    Default Cpt assistant on cerumen removal

    As mentioned by another, you will probably want to check the CPT Assistant that qualifies cerumen removal. It must be impacted and certain instruments must be utilized in order to qualify for the use of this code.

    CPT Assistant July 2005 states that to qualify for "impacted cerumen", the condition must be one or more of the following:
    -impairs exam
    -causing symptoms
    -inflammatory
    -removal requires magnification and/or multiple instrumenation to remove.

    You may wish to refer to this CPT Assistant to clarify whether the use of this code is appropriate.

    msd CPC

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