Cerumen Removal 2014

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April 3, 2014

Question:  

I noticed that I am getting denials from Medicare when I use modifier 50, bilateral procedure on 69210. I thought we were allowed to bill with modifier 50 as of January 1, 2014. What should I do?

Answer:

This has been an ongoing issue since the code 69210 was revised effective January 1, 2014. Some payors are indeed recognizing modifier 50 on 69210 while others, including Medicare, are not. For Medicare, just report 69210 without any modifiers. Do not bill 69210-RT and 69210-LT thinking you’ll be paid for bilateral procedures – your claim will still be denied. Also, we’ve heard of practices billing 69210 on two separate claims in an attempt to get both services paid – don’t do this.

For more information, please click here to see the webinar that Kim Pollock gave a few weeks ago: Resolving Cerumen Coding Chaos – we think you’ll find it very helpful.