What is Procedure Code 69209?
What is procedure code 69209? The Current Procedural Terminology (CPT) code 69209 as maintained by American Medical Association, is a medical procedural code under the range - Removal Procedures on the External Ear. Click to see full answer.
Does CPT code 69209 need a modifier?
This code is included in the surgical section of CPT and correct coding requires that this be reported with modifier -50 for a bilateral procedure. In fact, there is a specific parenthetical note that states “For bilateral procedure, report 69209 with modifier -50”.
What is CPT code 69210?
If the patient has pain in the external ear as his/her only complaint and the removal of cerumen addresses that complaint, one should bill only for removal of the cerumen, CPT code 69210. If the patient also has symptoms of otitis media requiring further evaluation, then it may be justified to also bill for an E&M service with modifier –25.
Does CPT 69200 require a modifier?
· Code 69200 (removal of foreign body, proper application of modifier 50 increases reimbursement to 150 percent of the allowable fee schedule payment for the code to which the modifier is appended,4, Modifier 50 – Incorrect Usage. CPT Modifiers 101 · This modifier should be used in exceptional cases only, Removal of foreign body from external auditory canal; without general anesthesia , malignant lesion including margins,, use modifier , Hearing Screening Coding Fact Sheet · PDF ...
Is CPT 69209 a bilateral procedure?
The descriptors for codes 69209 & 69210 indicate that they are unilateral codes. For bilateral impacted cerumen removal, report these codes with modifier 50, Bilateral Procedure, appended. Note: Medicare does not allow the use of modifier 50 for impacted cerumen removal.
Do you need a modifier for 69209?
This code is included in the surgical section of CPT and correct coding requires that this be reported with modifier -50 for a bilateral procedure. In fact, there is a specific parenthetical note that states “For bilateral procedure, report 69209 with modifier -50”.
What is the difference between CPT 69209 and 69210?
Like CPT 69210, (removal of impacted cerumen requiring instrumentation, unilateral) 69209 requires that a physician or qualified healthcare professional make the decision to irrigate/lavage. However, unlike 69210, 69209 allows removal to be carried out by clinical staff.
Who can perform 69209?
nurseThe new code, 69209 (Removal impacted cerumen using irrigation/lavage unilateral) has no work value RVUs. As a result, the procedure can be performed by a nurse as presented in the clinical example from the AMA Editorial Panel.
Can a nurse Bill 69209?
Has anyone billed the 69209 and what is the reimbursement for it? 69210 requires the doctor perform the procedure and document instrumentation with diagnosis of cerumen impaction. 69209 can be done by the MA/Nurse as long as there is a cerumen impaction documented. this can be done by irrigation only.
Does Medicare pay for cerumen removal?
Medicare covers cerumen removal if billed by a physician, but not if billed by an audiologist. Medicare only covers diagnostic testing performed by audiologists, not treatment or surgical services.
How do you bill CPT code 69210 Bilateral to Medicare?
A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Alternatively, the coder could report code 69210 twice with modifiers -LT (left side) and -RT (right side).
Can a nurse remove impacted cerumen?
Ear irrigation is a procedure in which nurses flush their patient's ear canal with sterile water or saline solution. This is usually done to cleanse the ear canal of any discharge, soften and remove impacted ear wax, or extricate a foreign body from a patient's ear.
Can an office visit be billed with 69210?
When all of those conditions are met, an appropriate office visit E/M code may be reported with 69209 or 69210. Modifier 25 (significant and separately identifiable E/M service by the same physician on the same day of the procedure or other service) should be appended to the E/M visit code.
What is a cerumen removal?
Description. Impacted cerumen removal is the extraction of hardened or accumulated cerumen (ear wax) from the external auditory canal by mechanical means, such as irrigation or debridement.
What cerumen means?
earwaxDefinition of cerumen : earwax. Other Words from cerumen Example Sentences Learn More About cerumen.
Can you bill for cerumen removal if unsuccessful?
Nothing as far as billing would need to be reported for the unsuccessful removal in the other ear that day. Then on the next visit, if it qualifies for 69210, that would be billed alone for the other ear.
Does 69210 require a modifier?
When you are using 69210 for ear wax impaction, it is appropriate to use an E/M code (with modifier -25) if the patient received a true evaluation and management for a separate problem (such as bronchitis or pharyngitis) or for complicating problems (such as dizziness or otitis media).
What is a 25 modifier?
According to Medicare: Modifier 25 is used to facilitate billing of E/M services on the day of a procedure for which separate payment may be made. It is used to report a significant, separately identifiable E/M service by the same physician on the day of a procedure.
Does CPT 69200 require a modifier?
CPT guidelines require that the bilateral procedures be reported with modifier 50 and 1 unit of service (eg, 69200-50 x 1 unit). Some payers will require that the procedure be reported with modifier 50 and 2 units of service.
What is a 50 modifier?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).
What is CPT code 69209?
For 2016, Current Procedural Terminology (CPT ®) code 69209 Removal impacted cerumen using irrigation/lavage, unilateral was created. In order to help Otolaryngologist – Head and Neck Surgeons correctly code, the Academy helped the American Medical Association (AMA) draft a CPT Assistant article on the removal of impacted cerumen. The AMA CPT Assistant article “Removal of Impacted Cerumen,” can be found on page 7 of the January 2016 CPT Assistant and is republished with permission from the AMA here.
What is 69210 code?
For CY 2014, 69210 no longer includes the use of the microscope. As such, code 92504, Binocular microscopy (separate diagnostic procedure) can be reported in addition to 69210 if the operating microscope is used for cerumen removal.
What is the modifier for 69210?
For bilateral impacted cerumen removal, report code 69210 with modifier 50, Bilateral Procedure, appended.
When reporting an E/M visit and cerumen removal on the same date of service (DOS), what criteria?
When reporting an E/M visit and cerumen removal on the same date of service (DOS), the following criteria must be met: 1. The initial reason for the patient’s visit was separate from the cerumen removal. 2. Otoscopic examination of the tympanic membrane is not possible due to the impaction; 3.
Can an independent audiology bill 69210?
Independent audiologists cannot bill 69210. CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff.
Does CPT 69210 cover ear wax removal?
Payers typically will not cover simple, non-impacted earwax removal. This work is included in the E/M service and should be reported with an E/M code. Further, if earwax is removed by irrigation or lavage only, CPT 69210 should NOT be reported. New in 2016 is CPT code 69209 Removal impacted cerumen using irrigation/lavage, unilateral which may be used to report use of lavage or irrigation and represents practice expense only.
What modifier is used for 69210?
Also, follow the same modifier usage as 69210 — that is, use modifier 50 (Bilateral procedure) to report a bilateral procedure with 69209.
What is the surgical code for removing ear wax?
Physicians will have another way to report removing ear wax in 2016 now that surgical code 69209 (Removal impacted cerumen irrigation/lavage, unilateral) joins higher level 69210 (Removal impacted cerumen requiring instrumentation, unilateral) in the auditory system section.
Can you bill 69210 and 69209 at the same time?
When there’s no impaction, don’t use the 69000 series codes. “All non-impacted cerumen should be reported with an E/M,” advises Silvia. Also, you “cannot bill both [69209 and 69210] at the same time for the same ear,” she says.
What is 69210 bilateral?
Both 69209 and 69210 are unilateral procedures . For removal of impacted earwax from both ears, append modifier 50 Bilateral procedure to the appropriate code. In the example above of the 7-year-old child, if irrigation occurred in both ears, appropriate coding is 69209-50.#N#When billing Medicare payers, different bilateral rules apply for 69210. The 2016 Medicare National Physician Fee Schedule Relative Value File assigns 69210 a “2” bilateral indicator. This means, for Medicare payers, the relative value units assigned to 69210 “are already based on the procedure being performed as a bilateral procedure.” In contrast to CPT® instructions, the Centers for Medicare & Medicaid Services (CMS) allows us to report only one unit of 69210 for a bilateral procedure. CMS does allow us to bill a bilateral procedure for cerumen removal by lavage using 69209-50.#N#Finally, note that some payers may stipulate “advanced practitioner skill” is necessary to report removal of impacted earwax (i.e., payers may require that a physician provide 69209, 69210). Query your individual payers to be certain of their requirements.
What is the CPT code for cerumen removal?
CPT® guidelines tell us, “For cerumen removal that is not impacted, see E/M service code …” such as new or established office patient (99201-99215), subsequent hospital care (99231-99233), etc. In other words: If the earwax isn’t impacted, removal is included in the documented evaluation and management (E/M) service reported and may not be separately billed.#N#Per the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), cerumen is impacted if one or more of the following conditions are present: 1 Cerumen impairs the examination of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition; 2 Extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc.; 3 Cerumen is associated with foul odor, infection, or dermatitis; or 4 Obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician skills.
What is the code for earwax removal?
Code 69210 only captures the direct method of earwax removal utilizing curettes, hooks, forceps, and suction. Another less invasive method uses a continuous low pressure flow of liquid (eg, saline water) to gently loosen impacted cerumen and flush it out … Code 69209 enables the irrigation or lavage method of impacted cerumen removal to be separately reported…
Can you report 69209?
You may report a single unit of either 69209 or 69210 (never both), per ear treated. As an example of proper reporting for 69209, CPT® Changes 2016: An Insider’s View provides the following:
Can you charge 69210 for irrigation?
Regarding Lee, you can charge 69210 being that you used currette as well as irrigation.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L33945-Cerumen (Earwax) Removal.
ICD-10-CM Codes that Support Medical Necessity
It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM (e.g., to the fourth or fifth digit). The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
