Forum - Questions & Answers

Oct 18th, 2010 - dsharma83

69200

I lost hearing and was in pain in my right ear after swimming one evening, and visited an ENT specialist who used a suction device to clear out ear wax.I was billed CPT code 69200. The insurance company is denying my claim for "Physician Visit" because 69200 is a "surgical procedure" and my policy does not cover physician visits for surgical procedures. I find it hard to believe that ear wax removal constitutes as surgery. Does it? Is there a better code to use for my procedure that is not surgery?Is 69210 considered surgery as well? I have already appealed and have been denied that as well.

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Oct 19th, 2010 -

It is a surgery

In short anything that is "done" to a patient is called surgery; the other choice is what we call an E&M visit- evaluation and management. You may want to ask the physician about changing the code to an E&M code. If you presented with "hearing loss" then the doctor did do an evaluation and it could be billed that way. If you presented with "ear clogged by wax" then the surgery code is correct.

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Oct 19th, 2010 - jschmutz   323 

69210 for cerumen removal

If the physician removed ear wax then why is he not reporting 69210 (instead of 69200)?

Unfortunately these are considered surgical codes. I recently had a superficial skin cyst removed in the office and my insurance wouldn't cover it because it was considered a surgical procedure.

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Oct 19th, 2010 - drgo77 39 

69200

I agree. I use 69200 to remove a foreign body (bean, screw, Silly Putty, etc)
69210 is for cerumen removal.

I always code an E&M

either the pt presents with hearing loss, or ear pain. Even if the chief complaint is "excess ear wax", 380.4 ceruminosis, I still do an exam and then remove with wax and code the 69210.

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Oct 19th, 2010 -

I saw the code error

but I figured it was a typo as the person appears to be a lay person (or maybe it was not wax - ewww).

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