69210

please confirm for me; if you have a pt present with ear pain, find impacted wax and remove with instrument...can you bill an OV as well w/ 25 or does it have to be significantly different such as leg pain, or cough and btw I have ear pain. Is the evaluation and management portion of the ear pain included in the 69210.

69210

I bill for this all the time. I bill the office visit 99213-25 using the diagnosis ear pain. Then bill the 69210 using the diagnosis impacted ceremun. I have never had a problem.

69210

This may be redundant...but with push back I must ask...What if a Nurse removes impacted wax with a toll such as a wax currette?

69210

I think the confusion about billing for this comes from the fact that payers have developed their own policies about it, and that they feel it has been abused. There is an article in the database about the requirements for the code (billing provider, not nurse must do it, lavage isn't sufficient, must use instrumentation.)

Beyond that, payers should pay for it when it is medically necessary and documented, even for the same diagnosis code. You would need modifier 25 on the E/M, of course. Which isn't to say that they will. I talked to an ENT physician yesterday who told me that the president of one of her major health insurance companies had told her personally, over the phone, that they would never pay for it with an E/M service, and to just "bill a higher level E/M service." Not the advice I gave!!!

If a patient returns for a planned, repeat cerumen removal, bill only the procedure.

I wish there was a definitive answer, but I can only suggest: follow correct coding for the procedure (as in the article on cerumen removal), document an E/M separately when done, based only on the level of history ,exam, MDM. Don't bill it if the billing provider didn't personally perform it. Be prepared to write some of them off, if you participate and the payer says, "it is bundled with the E/M"

69210

so if a nurse does this and we all know they do somewhere in the world....is it rolled into the e&m if the Dr saw the pt as well or if they did not see the DR do they bill a 99211, or is this not within their scope of practcie per CPT and AMA?

69210

Unfortunately for primary care and ENT practices, I don't think it's billable by a nurse using any code. CPT explicitly says no to it. Using 99211 is incorrect, because there is another CPT code that more accurately describes the service.

That's my opinion.

Others?

69210

That is what I thought, because removing with a tool needs the expertise of a Practitioner not a nurse (?)...However, if a nurse flushes/irrigates then they would bill a 99211 or are they not allowed to preform that procedure? I need to instruct the Offices to not have their nurse preform this or how to bill it and I know there will be push back so I am lining up my ducks!

Nurse/MA does the flushing

"However, if a nurse flushes/irrigates then they would bill a 99211 or are they not allowed to preform that procedure?"

Did you ever get an answer to this, I have the same question and situation in my office. Since the instrument is not used, it does not qualify as a 69210, so there is not a more appropriate CPT to use. Therefore can we bill the 99211, and is it allowed for the nurse/MA to do since there is no instrument?
Thanks for the advise.