I lost hearing and was in pain in my right ear after swimming one evening, and visited an ENT specialist who used a suction device to clear out ear wax.I was billed CPT code 69200. The insurance company is denying my claim for "Physician Visit" because 69200 is a "surgical procedure" and my policy does not cover physician visits for surgical procedures. I find it hard to believe that ear wax removal constitutes as surgery. Does it? Is there a better code to use for my procedure that is not surgery?Is 69210 considered surgery as well? I have already appealed and have been denied that as well.
In short anything that is "done" to a patient is called surgery; the other choice is what we call an E&M visit- evaluation and management. You may want to ask the physician about changing the code to an E&M code. If you presented with "hearing loss" then the doctor did do an evaluation and it could be billed that way. If you presented with "ear clogged by wax" then the surgery code is correct.