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Topic Originator: CRYSTIL CARIE
Post Date March 18, 2015 @ 4:35 PM
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CRYSTIL CARIE
MODIFIERMarch 18, 2015 @ 4:35 PM Reply  |  Email Friend   |  |Print  |  Top

DO I NEED TO USE A MODIFER 25 ON 99215 IF I'M BILLING 69210 FOR SAME DATE OF SERVICE?

ESWARAN PANDIYARAJ
MODIFIERMarch 30, 2015 @ 7:28 AM Reply  |  Email Friend   |  |Print  |  Top

Hi,

For instance, if you used an operating microscope and forceps to remove impacted cerumen, you should assign 69210. Link 380.4 (impacted cerumen) to 69210 to show medical necessity. Payers vary on their guidelines regarding acceptable methods for removing impacted cerumen, so check with your carrier for specific requirements.

But if you used a simple instrument such as a curette, and the cerumen came out easily, you should include the procedure in whatever level of E&M code is appropriate (99201-99205 or 99211-99215).

You can use 69210 and bill for an E&M service only if you can document that you saw the patient for a reason other than cerumen removal. Attach modifier 25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E&M code.

Thanks ,

Eswaran Pandiyaraj- COC



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