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Removal of impacted cerumen

  1. Default
    Medical Coding Books
    Quote Originally Posted by dbarker View Post
    So, I have another question now. If someone is referred to our clinic for an ear wash or even removal by instrumentation and the nurse does it.......if the documentation is there, would it be appropriate to charge a 99212 (minimal) and not the procedure? It is a nurse visit after all.
    Ok, understanding you changed the 99212 to a 99211 in a second email.

    The first question we need to look at is whether it is in RN, LPN, or MA scope of practice in your state allows their licensure to perform cerumen impaction removal using instrumentation.

    Do you have your state's scope of practice available?

  2. Default
    We are in Illinois and that services is allowed. Basically my question is just asking as to whether we could charge a nurse E&M if she does this service. We wouldn't be charging for the earwash itself.....only the minimal E&M.

  3. #33
    Location
    Milwaukee WI
    Posts
    4,466
    Default E/M only
    If no instrumentation is used, but there is an ear wash you code the appropriate level E/M.

    F Tessa Bartels, CPC, CEMC

  4. Default
    Quote Originally Posted by dbarker View Post
    We are in Illinois and that services is allowed. Basically my question is just asking as to whether we could charge a nurse E&M if she does this service. We wouldn't be charging for the earwash itself.....only the minimal E&M.
    As there is no procedure code for a nurse visit, there is the minimal E&M, as you indicate in the last sentence, that could be charged if evaluation and management are performed under the doctor's direct supervision.

    The direct supervision does not mean the doctor has to be in the room, however the doctor must be in the suite or office.

    If chart documentation indicates the doctor ordered the patient to come for a service with the nurse and the nurse performs evaluation and management of a patient under the doctor's direct supervision and documents the evaluation and management, then yes the 99211 E&M service would be appropriate.

    As a community, the term 99211 as a "nurse visit" truly is simply a slang. 99211 does not require the same components as other E&M services, however it is an evaluation and management service.

    The bottom line is this in my humble opinion; if there is medical necessity, if there is documentation to support the physician ordered the service, if there is documentation of the service, then a service is billable.

    Does this help?

    The bottom line is,

  5. Default Impacted cerumen
    How is this proceedure being coded because everytime I bill I get denials stating that it is part of the ov.(global)? cr

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