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cpc - with cpt code

  1. #1
    Default cpc - with cpt code
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    Can anybody help me with cpt code 69210. Can I bill a 99392
    -25 and 69210 and get paid for it. HELP

  2. #2
    More than likely, as long as the records show a distinct difference in the E/M services and the earwax removal. As long as removing the cerumen is not a vital step in evaluating or treating the patient (like it would be if they came in complaining of ear pain, for example), and the E/M elements are clearly documented, it's a separately billable service. (Check with your local Medicare/Medicaid providers, though, for specifics on their coverage criteria. My background is commercial insurance.

    It is a procedure that's treated like a surgery for modifier purposes (much like 96372 is). If documentation supports billing both, the E/M will require a 25 modifier to process. Otherwise, it will deny as incidental to 69210. Hope that helps!

  3. #3
    Milwaukee WI
    Default Please NOTE
    Medical Billing
    Please note - IRRIGATION does NOT equal CPT 69210. Documentation for 69210 MUST include a physician diagnosis of impacted cerumen, and must include procedure description that involves the use of instruments to remove the impacted cerumen.

    There must be at least a dozen posts on this forum on this topic. You might want to research and read them.

    F Tessa Bartels, CPC, CEMC

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