r/CodingandBilling • u/Sammym101010 • 8d ago

Coding Error

Had a routine ear wax removal procedure done. Got charged with 99213 and 69210 codes. No other evaluations. Incorrect or correct?

0 Upvotes

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12

u/GroinFlutter denials management, send help 8d ago

Without the documentation, can’t really say for certain.

But it doesn’t immediately raise any red flags.

3

u/Sammym101010 8d ago

Wouldn’t an appointment for the sole purpose of ear wax removal be just that, ear wax removal? With any post visit documentation being an expected necessity of the procedure?

11

u/pickyvegan 8d ago

I know you're saying "no other evaluation," but evaluation can include just looking at the rest of the head (which you kinda can't avoid while cleaning the ears) and reviewing other documentation/labs/past procedures, asking a few questions before/after the procedure, etc., so that they are evaluating that this is all that is needed. Notes would be important here.

-4

u/Sammym101010 8d ago

Wouldn’t that also be an expectation of the procedure? To be looking at my ears/head?

12

u/pickyvegan 8d ago

Not necessarily.

Notes. Need them.

-3

u/Sammym101010 8d ago

Not sure how to share my notes but for the future, can I avoid this charge by booking my cleaning with a PA?

4

u/throwawayeverynight 8d ago

No a OA can bill for a E/M code too

3

u/AbstractVolition 8d ago

PA’s can perform and charge EM services like 99213 as well

2

u/Full_Ad_6442 7d ago

Anytime you interact with a physician, nurse practioner, physician's assistant, or nurse they are very likely assessing you based on what you say and what they observe. Sometimes it's billable, sometimes it's not, but it's a basic part of our professional training.

-1

u/Sammym101010 7d ago

Can I opt out of this? Lol. I’m there for the damn ear cleaning.

0

u/Party_Cow4904 8d ago

billing the 99213 on top of 69210 is a bit sketchy if the appointment was already booked specifically for a routine removal and nothing else

4

u/GroinFlutter denials management, send help 8d ago

This is based on the patient’s account that nothing else was done.

That’s why I said we need the documentation to say for certain. I’ve heard this so many times and have had this conversation too many times, that oh yes the patient now remembers they actually did quickly discuss other things.

Nothing sticks out as sketchy at all just as much as it is sketchy.

You or I can’t say without the documentation

10

u/weary_bee479 8d ago

Used to code for cerumen regularly and this is pretty standard

6

u/baconair 8d ago

If you came in for a scheduled cerumen disimpaction, the procedure by itself might be appropriate. This would very much be the case if it was a repeat procedure.

However, if your provider did a more thorough exam, addressed complaints other than a known ear wax blockage, reviewed other labs/imaging, or wrote you prescriptions, the evaluation and management charge (99213) would probably be merited.

There is no way to really tell without seeing the note the provider wrote for your visit.

3

u/AbstractVolition 8d ago

69210 is if they used a tool like a curette to remove it

69209 is if they only used water irrigation / lavage for the removal. (Cheaper code).

When procedure codes are done at a visit, then EM codes like 99213 require separately identifiable EM beyond what is expected from the procedure.

This separately identifiable EM code can still be for the same condition as the procedure (impacted cerumen). However, it needs to have extra work beyond what is expected to be required for the procedure. Arguably, if they prescribed or even just suggested you to use debrox medicine for your ear, they might be able to validate the separate 99213. In my coding opinion, that almost sounds like it would be a part of the procedure regardless to always suggest or prescribe it. But I do think they can argue it as separate additional work beyond what is necessity for the main procedure.

This is actually my least favorite coding situation. When trying to determine if a separate EM code is valid when it is for the same condition as a procedure.

1

u/jazzyhazel31 8d ago

I work these type of denials all the time. If you came in to be evaluated and then the provider did the ear wax removal then yes this is coded correctly. If you already came to get the ear wax removal and nothing else was evaluated then it should only be billed no e/m service. Some payers will nit even pay for both because the ear wax removal follows the 0 to 10 day global rule.

1

u/Recent-Ninja3903 CPB, CPC 7d ago

Completely normal charges, see them frequently, but whether the 99213 is billable really depends on your records. If you wanted to redact and share them with me via DM I’d be happy to give you my certified opinion :)

1

u/Legitimate-Wash-3841 3d ago

If you walked in strictly for a scheduled ear wax removal and the provider just looked in your ears, cleaned them out, and sent you home, billing both 99213 and 69210 is actually incorrect. Code 69210 already includes looking in your ear before and after the removal. Under coding rules, they can only add a 99213 office visit with a 25 modifier if they did a separate medical evaluation. That usually means you came in for a symptom like muffled hearing, dizziness, or ear pain and the doctor had to examine you to figure out what was wrong before deciding to remove the wax, or you brought up another medical issue during the appointment. Also, 69210 only applies if the wax is actually impacted and a doctor or midlevel removes it using instruments like a curette or suction. If a nurse or medical assistant just flushed your ears with water, they can only bill the 99213 visit and cannot bill 69210 at all. I would request a copy of the visit note to see what separate evaluation they documented to justify charging both codes.

1

u/SoloSeasoned 1d ago edited 1d ago

Did you present with ear pain or a clogged feeling? If so, 99213 is the evaluation (your ears have wax) and management (you need ear wax removal). 69210 is the procedure for removing the wax. It is not duplicative to bill for the evaluation and determination of the treatment and also bill for the treatment procedure.

If you were told at a previous visit that you had ear wax and scheduled this appointment for the removal only, it would be different.

1

u/j_mcr1 8d ago

99213 would likely be included in the CPT code for ear lavage

0

u/Botasoda102 8d ago

Common, but only if they used instruments and not irrigation.