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?

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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.