NCCI Edits for CPT Codes 69210, 92550 and 92570

Effective from July 1, 2010, based on implemented edits from the National Correct Coding Initiative, Medicare will deny CPT code 69210 - Removal impacted cerumen (separate procedure), 1 or both ears as a column 2 code when performed with the newly released CPT codes 92550 - Tympanometry and reflex threshold measurements, or 92570 - Acoustic immittance testing, includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing. The NCCI edits for these code pairs have a modifier subscript of “0” meaning, “There are no circumstances in which a modifier would be appropriate.”When impacted cerumen is removed on the same date of service as CPT codes 92550 or 92570 you will not be able to override Medicare’s edits to bundle payment for each code pair with any modifier. As a result, you will want to bill the removal of the impacted cerumen with the HCPCS Level II G0268 - Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing in addition to 92550 or 92570 (based on the service furnished on the date of service).

The same edit applies when impacted cerumen is removed on the same date of service with other audiologic function tests within the CPT code range of 92552 – 92596 (with the exception of the following CPT codes that are not covered by Medicare: 92560 -Bekesy audiometry; screening; 92590 - Hearing aid examination and selection; monaural; 92591 - Hearing aid examination and selection; binaural; 92592 - Hearing aid check; monaural; 92593 - Hearing aid check; binaural; 92594 - Electroacoustic evaluation for hearing aid; monaural; 92595 - Electroacoustic evaluation for hearing aid; binaural). Download a list of the current NCCI edits


Posted April 1, 2010

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