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99214 and 69210 HELP

  1. #1
    Default 99214 and 69210 HELP
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    I need help. I work for an internal medicine practice and pt came in for blood work to check CMP and thyroid, he has a history of high cholesterol and hypothyroid. He also complained of ear stuffyness and the exam showed an impacted cerumen, which was removed. BCBS paid for the 69210 but bundled the 99214 and all the lab codes into the 69210. I have tried mod 25 on the 99214( which was denied),then 59 on 69210 and sent a copy of the records, but still they say that 99214 is disallowed with 69210....

  2. #2
    Columbia, MO
    First, did the physician remove the cerumen or was it a nurse or other ancillary person?
    if not the physician then it cannot be billed it is inclusive to office encounter.
    second, if done by provider, did he use a scoop or currette, or was it an irrigation?
    if it was an irrigation then you cannot bill the 69210 it is inclusive.
    third, do you have a separate procedure note documented?
    if not then they are likely to state the entire office encounter was for the cerumen removal.
    Just a few thoughts for you to look at.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Let me re-start this question. First off i'm new to the office and have found myself doing a lot of recovery. This claim is from last year and i am trying to figure out what to do to correct the mistakes of the previous biller.

    The physician removed the cermun using irrigation, and coded 69120. Which was the only line item paid. Knowing that this was not coded correctly, i am focused on getting the other procedures done that day unbundled.

    The Patients chief complaint was high cholerterol, hypothyroid and the physican did lab work.The office visit and labs were all bunddled into the 69120.

  4. #4
    Greeley, Colorado
    Do a claim action request removing 69210 (as simple irrigation does not qualify for this code) and request proper reimbursement for 99214.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    I'd agree...we have some plans that won't cover a 69210 if billed with an E/M , even when the appropriate mod 25 is present. It's a specific exclusion to the plan.

  6. #6
    Just thought I would add this, per the lay description under the 69210:
    Under direct visualization, the physician removes impacted cerumen (ear wax) using suction, a cerumen spoon or delicate forceps. If no infection is present, the ear canal may be irrigated.

  7. #7
    Evansville Indiana
    Default 69210
    I believe that that means if after the impaction is removed, no infection is found then ear may be irrigated also.

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