Patricia Posted Thu 13th of April, 2017 13:11:56 PM
We are getting denied on all of the Cerumen Removal for the above CPT code? Denial reason is patient's history? There is no history on this code for the patients?
Please let me know what I am missing.
SuperCoder Answered Fri 14th of April, 2017 10:53:02 AM
Hi, if that is the reason for denial, then you should check the patient’s record to ensure proper documentation requirements are met for billing code 69210 such as:
If the patient presents with an impacted cerumen, then the service described by 69210 is considered reasonable. Check the location of cerumen impaction, whether the physician used instrumentation such as otoscope, forceps, microscope, etc.
According to the American Academy of Otolaryngology (Head and Neck Surgery), cerumen impaction criteria is fulfilled either when the patient presents with cerumen that impairs the examination of the ear; the patient presents with symptoms such as pain, itching, hearing loss, because of cerumen impaction; cerumen is infected presenting as signs of foul odor or inflammation; or the cerumen impaction is such that the physician has to use magnification and instruments and use his skills for the cerumen removal.
Hope this helps!! Please let us know in case of any further clarification on this. Thank you.