Code description change for cerumen removal won’t change payment, at least for Medicare

September 3rd, 2014 - Scott Kraft

Highly billed code 69210, for impacted cerumen removal, got a tweak to its code description for 2014 that changes the rules for billing the service but, at least for Medicare, won’t change how you get paid for it.

CPT® changes for 2014 made 69210 a unilateral code, meaning that by the descriptor, it’s for the removal of impacted cerumen from a single ear. The actual code description is “Removal impacted cerumen requiring instrumentation, unilateral.”

Prior to this year, the description for 69210 was for removal of impacted cerumen in one or both ears, and the payment amount did not change.

By rule, when billing 69210 for the removal of impacted cerumen from both ears in 2014, you would attach modifier 50 because the service is done bilaterally.

But you won’t get paid for two units of the service when modifier 50 is applied, at least not by Medicare. In a Dec. 10, 2013, posting in the Federal Register, CMS said that it did not agree with the contention by the AMA’s Relative Value Update Committee that the service would be billed bilaterally only 10 percent of the time.

As a result, CMS determined that, at least for Medicare, it would maintain the work relative value units at the same level in 2014 as in 2013 and allow only one unit of service to be billed with any given encounter. 69210 has a bilateral status indicator of 2 in the Medicare Physician Fee Schedule Final Rule in 2014, meaning that bilateral payment rules do not apply.

Other payers may allow for bilateral payment for this service and you would need to check with each of them to determine their policies. CMS believes the service is done bilaterally far more than 10 percent of the time, stating that the biological process of impaction typically affects both ears.

One last reminder: In order to bill 69210, the cerumen has to be impacted and removed with equipment. Removal of non-impacted cerumen is bundled into an E/M encounter billed for that day. Likewise, in order to bill an E/M encounter on the same date of service as 69210, the E/M must be for a separately identifiable service.

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