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Patricia Posted Fri 10th of March, 2017 13:12:09 PM
Please let me know, if the 50 modifier is being used as follows and if correct. I am aware the bilateral is allowed. 69210 quantity 1 without modidifier 69210 quantity 1 with 50 modifier or is it: 69210 quantity 2 with a modifier. Please let me know... Thanks for my health.
SuperCoder Answered Tue 14th of March, 2017 09:21:59 AM

Hi Patricia,

CPT 69210 (Removal impacted cerumen requiring instrumentation, unilateral).These are unilateral procedures.

If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code. (e.g: 69210, 69210 – 50), while others require identification of the service only once with modifier 50 appended. (e.g 69210 – 50). So check with your payer. However, Medicare allows only one unit of this code to be billed even if both ears are treated.

Removing wax that is not impacted does not warrant the reporting of code 69210. Rather, that work would appropriately be reported with an evaluation and management (E/M) code regardless of how it is removed (such as lavage, irrigation, etc). Hope it helps.

Patricia Posted Tue 14th of March, 2017 12:17:09 PM
Thank you this does help.
Patricia Posted Tue 14th of March, 2017 12:39:00 PM
while others require identification of the service only once with modifier 50 appended. (e.g 69210 – 50) - SORRY ON THIS WOULD YOU CHANGE THE QUANTITY?
SuperCoder Answered Wed 15th of March, 2017 06:18:46 AM

As per coding guidelines, appropriate billing will be (69210 with modifier 50). Also, as per payer specific guidelines, we may bill 69210 on a single claim line and 69210 with 50 modifier on claim line 2. This kind of billing would not change the quantity or affect the reimbursement. Thank you.
 

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