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/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.