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Humana and cerumen removal

Kimberly Posted Wed 07th of December, 2011 19:32:26 PM

We are having problems with Humana paying cerumen and audio testing on the same day, the cerumen was removed by the physician, the audio testing was done by an audiologist, they deny 69210 as inclusive of audio test, but will not allow the G code for cerumen. Can others tell me how they are billing this scenario.

SuperCoder Answered Thu 08th of December, 2011 07:13:29 AM

You can only report 69210 with a diagnosis of impacted cerumen (380.4). Removing wax that is not impacted does not justify 69210. Instead, capture this work with an E/M code (99201-99215, Office or Other Outpatient Services) — no matter how the provider removes the wax.

So first confirm the medical necessity as impacted cerumen and then re-appeal.

Kimberly Posted Thu 08th of December, 2011 21:26:34 PM

the cerumen was impacted, i am trying to figure out how to get around the bundle with the audio codes

Gloria Answered Thu 08th of December, 2011 21:49:40 PM

We have no carriers that pay for cerumen removal and an audio on the same day. Recourses are 1) remove the cerumen and schedule the audio on another day, or 2) charge the appropriate E&M level of care and do the audio the same day.

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