Use modifier 50 if cerumen is removed from both ears. The final 2015 work rvus for these codes will now be as follows. Jun 12, 2017 per cpt assistant march 2016, for the removal of cerumen that is not impacted, report the appropriate evaluation and management em service code eg, 9920199215, 9922199223. We are hiring a scribe for the doctor because it will help improve his documentation. The cms annually updates the national correct coding initiative coding policy manual for medicare services coding policy manual. Cpt 2016 professional edition current procedural terminology, professional ed. Sep 01, 2007 69210 always involves the diagnosis of impacted cerumen, so it seems reasonable to always attach the code for impacted cerumen 380. Modifer 50, bilateral procedure health partners plans.
Seems pretty straightforward, doesnt it well, hear is the issue. Specialty newsletters free trial books free demo icd10 charts code connect with ama cpt. It is yet again another different look at an authors view. What i found is if you bill to 69210 you will be audited.
For bilateral procedure, report 69210 with modifier. Mar 30, 2015 cpt payment for medicare 69210 pdf download. Introduction to cpt surgery guidelines, hcpcs, and modifiers. Cpt or hcpcs codes with bilateral in their intent or with bilateral. Someone told me to bill an em code like 99212 or 99202, instead of 69210 when removing impacted cerumen with instrumentation. I was just told that guideline has changed and that anything that goes in the body im thinking like a curette to remove cerumen, even if it is not impacted, is now billable. Cpt changes, cpt assistant, and clinical examples in radiology citations provides crossreferenced information in popular ama resources that can enhance your understanding of the cpt code set. Jun 11, 2015 medicare to provide reimbursement for services provided to. Billing and reimbursement for cpt code 69210 or hcpcs code g0268 is. Jan 26, 2017 physician participation in the maryland medicaid program. Cpt 69210, under removal procedures on the external ear the current procedural terminology cpt code 69210 as maintained by american medical association, is a medical procedural code under the range removal procedures on the external ear. Across chapters in this book, we have marked the consultation codes 9924199255 with an asterisk.
Jun 11, 2015 patient was billed using cpt codes 99347 through 99350. Coding for removal of impacted cerumen 69210 journal of. Isread more mastoidectomy code question december 5, 2019 question. For many payers, a bilateral procedure may be reported using a single unit of 69210, with modifier 50 bilateral procedure appended, as indicated in the cpt 2014 codebook. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download medicare benefits pdf download medicare coverage pdf download medicare part d pdf download medicare part b pdf download billing 69210. Cfhp 2016 claims audit plan community first health plans. A modifier 50, bilateral procedure page 3 modifier 50 is considered a payment modifier, rather than an informational modifier.
The american medical association ama has published the 2016 updates to cpt codes. Only a few areas do not have any changes this year there are no deleted or changed modifiers and there are no changes to the anesthesia chapter of cpt. Cms does not construe this as a change to the mac statement of. Below is a brief summary of the changes to pain management codes. Note, however, that the 2014 medicare national physician fee schedule relative value file assigns 69210 a 2 bilateral indicator. Removal procedures on the external ear cpt code information is available to subscribers and includes the cpt code number, short description, long description, guidelines and more.
Modifier for 69210 medical billing and coding forum aapc. Feb 11, 2014 to account for situations in which the procedure is provided on both ears at the same encounter, cpt 2014 states, for bilateral procedure, report 69210 with modifier 50. Informational wage rates by occupation montana labor market. Current procedural terminology cpt current procedural terminology professional edition or read online forfree, please click the link buttom. There are cases that the doctor can provide documentation that it is the correct procedure and should be. Coding for removal of impacted cerumen 69210 journal. Effective in 2014, the american medical association ama cpt manual identifies cpt code 69210 removal impacted cerumen requiring instrumentation, unilateral as a unilateral procedure.
A revised annual version of the national correct coding initiative policy manual for medicare services effective january 1, 2020 was posted with a revision date of november 12, 2019. The cpt 2018 professional edition codebook covers hundreds of code, guideline and text changes and features. As an example, verno notes the 69210 policy for blue crossblue shield. Hcpcs tne codes, several flexible transoral esophagoscopy codes, cpt 69210 removal 2014 medicare physician fee schedule pdf centers for medicare. Code 69209 will not be reported in conjunction with code 69210 when performed on the same ear. Spiral current procedural terminology cpt professional. Aaohns statement on reimbursement of cpt 69210 and. The cerumen removal requires the skill of a physician, or the removal is directly supervised by a physician and the removal requires a significant amount of time and effort, states the policy. An insiders view confirms, impacted cerumen is typically extremely hard. The centers for medicare and medicaid cms published information in the 2014 opps final rule indicating that. Current cms policy considers removal of cerumen a indictment us department of justice. Per cpt assistant march 2016, for the removal of cerumen that is not impacted, report the appropriate evaluation and management em. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download medicare benefits pdf download medicare part b pdf download 69210 bilateral 2016. Medicaid reimbursement for the removal of impacted cerumen using cpt procedure, nys medicaid considers cpt code 69210 as a bilateral.
Cpt code 69210 removal procedures on the external ear. This is used as part of a vng test battery when billing medicare except in florida. Medicare replacement pdf download medicare benefits pdf download medicare part b pdf download replacement code for 69210 with united healthcare. Removal impacted cerumen separate procedure, one or both ears. Rural health clinic qualifying visit list rhc qvl cms. Cms has determined that, regardless of unilateral or bilateral, 69210 will remain bilateral and will allow only one unit per date of service billed. The physician may report current procedural terminology cpt code 69210 for removal of impacted cerumen. The rules that apply to the two cerumen removal codes now available for use mean that auditors will need to scrutinize the documentation closely in order to ensure codes are being used correctly. Cpt 99392, 69210, 69209 medical billing and coding. Billing and coding tips for 69210 manual removal of. There has been a recent surge in calls to our provider contact center regarding cpt code 69210 removal of impacted ear wax. Destination page number search scope search text search scope search text. Before, it needed to state that the cerumen was impacted to be able to bill cpt 69210. Coding for cerumen removal aap pediatric coding newsletter.
Procedure code 69209, 69210, g0268 medical billing and. This is also a great time to upload the 2016 medicare allowables for your locality and for any payer contracts that. Payment files were issued to contractors based upon the cy 2016 medicare physician fee schedule mpfs final rule, published in the federal register on november 16, 2015, to be effective for services furnished between january 1, 2016, and december 31, 2016. If you are attempting to code an em code in addition to code 69210. The billing procedure for ear lavage cpt 69210 with blue cross and blue shield. In order to report code 69210 removal impacted cerumen requiring. Our internist performed removal of cerumen impaction of both the ears. Payment will not be made for 69210, even if a modifier is used.
Medicare will pay the same amount for 69210 whether it is performed on one ear or two. Cpt 99392, 69210, 69209 cerumen removal medical billing and. Medicare reimbursement for 69210 will only be made for one unit of service, regardless of whether one or two ears are involved. To begin your search, select the following criteria. Cpt 2016 professional edition current procedural terminology. In 2016, the use program is expected to be released in the first half of 2015.
Sep 01, 2014 for many payers, a bilateral procedure may be reported using a single unit of 69210, with modifier 50 bilateral procedure appended, as indicated in the cpt 2014 codebook. Cpt states, for bilateral procedure, report 69210 with modifier 50. Effective from july 1, 2010, based on implemented edits from the national correct coding initiative, medicare will deny cpt code 69210 removal impacted cerumen separate procedure, 1 or both ears as a column 2 code when performed with the newly released cpt codes 92550 tympanometry and reflex threshold measurements, or 92570 acoustic immittance testing. Standardization of a codeediting system white paper ncvhs. As for everything else, grab your 2016 cpt code book or digital version and follow along. Jun 11, 2015 patients are billed using cpt codes 99347 through 99350.
If the provider removes impacted cerumen from both the right and left ears, you may report a bilateral procedure. Revisions were made in chapter viii section d ophthalmology, chapter ix, section e nuclear medicine, section f radiation oncology and chapter x, section a introduction, section f. Auditing for cerumen removal codes 69209, 69210 findacode. How to use the searchable medicare physician fee schedule mpfs. Cpt 99392, 69210, 69209 cerumen removal medical billing. When billing medicare for 69210, a provider should be cautioned that medicare, blue cross and other carriers do not consider lavage, or washing of ears, to be the same as described in the cpt codebook or medicare carrier manual as 69210. Subscribe today coding coaches use of a scribe december 19, 2019 question. Claim submission information there has been a recent surge in calls to our provider contact center regarding cpt code 69210 removal of impacted ear wax. Does unitedhealthcare accept modifier 50 on all codes where the cpt book indicates coding guidelines to. However, the consultation codes have not been removed from the cpt manual and it is at the discretion of other payers to decide to accept these services. Coding and reimbursement michigan audiology coalition.
The definition of medically necessary for medicare. Dec, 20 the medicare administrative contractor is hereby advised that this constitutes technical direction as defined in your contract. The font is big enough to not need a magnifying glass to read. Is it ok to code 69641, 69642, and 69643 for procedures performed on. For additional information about coding for 69209, 69210, see also the january 2016 cpt assistant. Cpt code 69210 removal of impacted cerumen requiring instrumentation may. Since the health insurance portability and accountability act of 1996 hipaa requires. Check instrumentation for clues to accurate 69210 coding. Feb 1, 2016 effective january 15, 2016, eligible consumers with medicaid may now procedure, nys medicaid considers cpt code 69210 as a bilateral revised modification to the medically unlikely edit mue program. The removal of impacted cerumen 69209, 69210, g0268 is only medically necessary when reported with a diagnosis of impacted cerumen icd10 codes h61. To report a bilateral procedure, append modifier 50 with 2 in the units field.
Either cpt code 69209 and 69210 is reported for a unilateral service and modifier 50 bilateral procedure is appended when the service is performed. The purpose of this article is to clarify claim submission instructions when this service is performed bilaterally. The current procedural terminology cpt code 69210 as maintained by american medical association, is a medical procedural code under the range removal procedures on the external ear. I know it seems like iam just highly suggesting every single one but i really am, these are very good books. Aetna anthem cigna hcsc humana regence uhc medicare. The coding policy manual should be utilized by carriers and fis as a general reference tool that explains the rationale for ncci edits. He removed the cerumen through instrumentation in one ear and by irrigation in another ear. Cpt code 99215 office or other outpatient isit t for established patiet this fact sheet is for informational purposes only and is not intended to guarantee payment for services, all services submitted to medicare must meet medical necessity guidelines. For example, cpt code 69210 removal impacted cerumen. Code 69210 captures the direct method of impacted earwax removal using curettes, hooks, forceps, and suction. In the july 2005 issue of cpt assistant, the ama clearly indicates that you should report 69210 onlywhen the following two criteria are both met. To reduce coding redundancies in the system, cpt deleted these and other codes and instituted one code. I just wanted to verify the guidelines for billing cerumen removal 69210.
Cpt code 69210 is eligible for reimbursement when the following criteria are met. Removal impacted cerumen requiring instrumentation, unilateral use modifier 50 if cerumen is removed from both ears 69210 6921050 both still have to be documented cannot report both together ie. Information does not constitute a guarantee of coverage or payment. Cerumen removal is considered incidental to audiologic function tests 92551 and 92552. Before we talk about how the two ear removal codes work together, here are some key things to know about 69209. Medicare turns deaf ear to cpt changes on cerumen removal fpm. Prior to the change, the descriptor for 69210 was removal impacted cerumen separate procedure, 1 or both ears. Cpt code 11042 for debridement of wound, and cpt code 69210 for removal of. Google medicare procedure code 69210 and some great articles came up. Cerumen removal coding depends on impaction, method aapc. Surgical services from the 60000 series of cpt billed with. Of course, the physician documentation should clearly demonstrate the presence of impacted cerumen, as defined above. The application is supported by at least one cpt or hcpac advisor representing practitioners for bilateral procedure, report 69210 with modifier. Cms made the decision to retain the edits that were in effect prior to january 1, 2020, and to delete the january 1, 2020 ptp edits for current procedural terminology cpt code pairs 97530 or 9715097161, 97530 or 9715097162, 97530 or 9715097163, 97530 or 9715097165, 97530 or 9715097166, 97530 or 9715097167, 97530 or 9715097169, 97530 or.
Published on tue feb 12, 2019 print friendly and pdf. The january 2016 issue of cpt assistant explains further when you should consider. Insurance paid first line but denied second line the charges for this procedure have been considered as part of another more comprehensive code. Attempted to remove impacted cerumen per lavage and then instrumentation was usedbill only the 69210. Feb 1, 2016 effective january 15, 2016, eligible consumers with medicaid may now select. Under medicare, cpt 69210, removal of impacted cerumen, one or both ears, is not recognized. Cpt code 92504 this is a separate procedure this has an xxx global designation 0. Delaware data have missing fees for procedure code 69210 remove impacted ear wax, and. The current health care payment system must be replaced by one in which health insurer. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download. Ucare will follow medicare guidelines and will process claims for procedure code 69210 based on a unit of one. Cpt also defines cpt code 69210 as a unilateral procedure that should be reported using a 50 modifier bilateral procedure if performed on both ears.