NARHC Forums

Getting Started

1. Login to reply to a thread or create a new thread
2. Adjust your Subscription settings
3. Post a message via your Email. (Help posting from email)

 Back to all Groups | Back to Topic
 
NARHC-News
Ear Wash 69210 Being Denied by Palmetto
Page 1 of 1
7/30/2020 @ 5:35:00 PM
Post 1 of 6

Contributor: Cassie Beesley, Springfield Clinic - Hillsboro East

We are having issues with Palmetto all of a sudden not wanting to pay for an ear wash 69210 with a CG modifier when that is the only service on the claim.  This would be when the patient strictly came in for the ear wash only and it was performed by a billable provider.  They keep telling us it is not a billable service.  We have provided them the Qualify Visit list and they are now telling us we are interpreting this wrong and that that list means they must be billed with an E/M visit.  I know this is not correct, as they are paying other services on the Qualifying List when they are the only code.  Any help appreciated?  Not sure what else we can provide them.
7/30/2020 @ 6:14:00 PM
Post 2 of 6

Contributor: Dana Gies, Associates in Family Practice RHCs

You have to have a visit with the CG modifier. Then add the 69210 x 1 or 2
It will not working alone.

Dana T Gies, CEO
Associates in Family Practice, P.A
208-934-5900
208-880-6076 cell


> On Jul 30, 2020, at 3:38 PM, NARHC News wrote:
>
> 
>
7/30/2020 @ 6:25:00 PM
Post 3 of 6

Contributor: Emilye Reetz, Ravalli Family Medicine

I was under the impression that the 69210 was not an "ear wash" but ears had to be cleaned out with something like a currette.  Did you provide notes and maybe they're stating that you are using the code incorrectly? 

7/31/2020 @ 10:08:00 AM
Post 4 of 6

Contributor: Cassie Beesley, Springfield Clinic - Hillsboro East

You are correct it is instrument used and performed by a provider. We billed this previously by itself with a 521 rev code and CG modifier and they paid correctly. There is no reason to bill an E/M code with this, as the 69210 was all that was done. Still billing the same way and they are denying. To me this should be no different than billing another standalone code like a joint injection or a lesion removal. Unless I am missing something.

[cid:image003.png@01D4EA20.04F19020] Cassie Beesley, CRHCP
Rural Health Clinic Manager
Springfield Clinic
Phone 217.528.7541 x44801



7/31/2020 @ 10:32:00 AM
Post 5 of 6

Contributor: Jackie King, Illinois Critical Access Hospital Network

Cassie,

Are you a Palmetto MAC in Illinois? Or are you having this with a different MAC and which one please?

Thanks,
Jackie


[cid:image001.png@01D579EB.4BFCECC0]

Jackie King, MSHI, CPC, COC, RH-CBS
Director of Clinical Informatics, HIM Consultant
Illinois Critical Access Hospital Network (ICAHN) | 1945 Van's Way, Princeton, IL 61356
P 815.875.2999 | F 815.875.2990 | jking@icahn.org | www.icahn.org





7/31/2020 @ 10:42:00 AM
Post 6 of 6

Contributor: Cassie Beesley, Springfield Clinic - Hillsboro East

Yes, Jackie we are a Palmetto MAC in Illinois. We were part of the grandfather a few years ago when they transitioned Cahaba MAC to Palmetto.

[cid:image003.png@01D4EA20.04F19020] Cassie Beesley, CRHCP
Rural Health Clinic Manager
Springfield Clinic
Phone 217.528.7541 x44801




Page 1 of 1