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audio with cerumen removal

Barbara Posted Thu 02nd of March, 2017 08:51:07 AM
i have always been taught that when billing audio same day to use the G0268 not the 69210..when we bill the 69210 to medicare with 92567 ..the 92567 gets denied - cant bill together, when i change to G0268 i get both paid..I got this email today from my billing manager and dont know if I should change my ways. She says because wax billed under DR and Audio under Audiologist we should use the 69210. Ladies, I was reviewing some take backs from Medicare and I noticed that some of you are using the G0268 code for cerumen removal when audio testing is performed on the same day. You should not be using that code you should use the regular 69210. The reason we don’t use the G0268 is because the 69210 gets billed under the physicians NPI and the audio testing is billed under the audiologist NPI so you do not need to use the G code.
SuperCoder Answered Fri 03rd of March, 2017 04:27:45 AM

G0268 (Removal of impacted cerumen [one or both ears] by physician on same date of service as audiologic function testing) is for a Medicare patient when the physician removes impacted cerumen on the same day that audiology is performed and it is still report G0268 for either one or both ears. When reporting cerumen removal for a Medicare patient, submit G0268 if audiology is also performed that day. Report 69210 (Removal impacted cerumen requiring instrumentation, unilateral) if no audiology is performed. G0268 remains a unilateral/bilateral code. Unfortunately, Medicare is treating 69210 just like G0268 and paying it the same amount whether it was performed unilaterally or bilaterally. Also note that, some Medicare carriers are actually denying 69210 if it is submitted with a 50 modifier even though AMA CPT® calls for the 50 modifier when performed bilaterally, check if you have appended modifier. On the other hand CPT 69210 and 92567 billing together, CPT 69210 will be denied always, as code 69210 is a column 2 code for 92567, these codes cannot be billed together in any circumstances, per CCI edits rule.

Barbara Posted Tue 02nd of July, 2019 11:01:52 AM
does this apply if an audiologist is the one doing the audio testing with a different NPI but billing under the same tax id ??
Barbara Posted Tue 02nd of July, 2019 11:02:04 AM
does this apply if an audiologist is the one doing the audio testing with a different NPI but billing under the same tax id ??
SuperCoder Answered Wed 03rd of July, 2019 04:37:40 AM

Hi Barbara,

Hope you are keeing well.

Since, this query date back long time, so it is requested to post it new tread.

Thank you!

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