Forum - Questions & Answers

Jun 8th, 2016 - autumnray

Unilateral in the CPT® book

We regularly clean cerumen (ear wax) from ears in our practice. We use code 69210. The CPT® description is "Removal impacted cerumen requiring instrumentation, unilateral". We have been using one charge regardless if we clean one side or both. Is this correct?

I know unilateral means one sided. It seems to me that we should use a -50 modifier and double the price if we remove cerumen from both sides.

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Jun 8th, 2016 - petunia 195 

re: Unilateral in the CPT® book

Yes. You can use the 50 modifier for the bilateral procedure. When we add a 50 modifier to the charge, our system increases the fee to 1.5 times the initial fee.

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Jun 9th, 2016 - LBAROGIANIS 250 

re: Unilateral in the CPT® book

This code has been revised for 2014 in the official CPT® description. Report this procedure for removal of cerumen impaction. It should not be reported for simple irrigation. This separate procedure by definition is usually a component of a more complex service and is not identified separately. When performed alone or with other unrelated procedures/services it may be reported. If performed alone, list the code; if performed with other procedures/services, list the code and append modifier 59. This is a unilateral procedure. If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code while others require identification of the service only once with modifier 50 appended. Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image).Code 69210 should not be reported for removal of PE tubes. The removal of ventilating tubes is included in the charge for insertion, regardless of how long afterwards removal occurs. For the removal of a foreign body from the external auditory canal, see 69200.

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