Third Party e-MDs Billing Tip: G Codes

Third Party e-MDs Billing Tip: G Codes

Space….The Final Frontier….. These are the voyages of the ever-changing G Codes.  CMS is always adjusting codes just as we’re getting used to them.  This year there are two updates/ changes to the code set that are common in the primary care setting.

Urine Drug Screens:

G0434 was replaced with G0477 as of 01/01/2016 (quick read test/cup) The QW for Medicare CLIA waived was not added to the fee schedule until 04/01/2016. So, UDT filed 01/01/2016 -03/31/2016 with a QW were rejected and had to be corrected to remove the QW. As of 04/01/2016 if you do not add the QW they will reject.

Cerumen Removal:

69210: Removal impacted cerumen requiring instrumentation, unilateral.

This was an issue in office because when most offices do lavage (ear wash) this code was for instrumentation (using curette, etc.) done by a provider. If the ear wash was done by a nurse (non-provider) it bundled into an office visit. This procedure can take a lot of time and the provider was not getting paid for it. So it made sense to clarify this point for reimbursement purposes.

As of 01/01/2016 this new code was created:

69209: Removal impacted cerumen using irrigation/lavage, unilateral.(ear wash) Which will pay 10.00-13.00 and does not bundle into the office visit.

Both codes are unilateral but can carry the 50 modifier if bilateral.

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