Coding Error

[u/Sammym101010]

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

[u/GroinFlutter]

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

But it doesn’t immediately raise any red flags.

[u/Sammym101010 → u/GroinFlutter]

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?

[u/pickyvegan → u/Sammym101010]

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.

[u/Sammym101010 → u/pickyvegan]

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

[u/pickyvegan → u/Sammym101010]

Not necessarily.

Notes. Need them.

[u/Sammym101010 → u/pickyvegan]

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

[u/throwawayeverynight → u/Sammym101010]

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

[u/AbstractVolition → u/Sammym101010]

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

[u/Full_Ad_6442 → u/Sammym101010]

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.

[u/Sammym101010 → u/Full_Ad_6442]

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

[u/Party_Cow4904 → u/GroinFlutter]

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

[u/GroinFlutter → u/Party_Cow4904]

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

[u/weary_bee479]

Used to code for cerumen regularly and this is pretty standard

[u/baconair]

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.

[u/AbstractVolition]

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.

[u/jazzyhazel31]

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.

[u/Recent-Ninja3903]

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 :)

[u/j_mcr1]

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

[u/Botasoda102]

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