I'm not Steve but couldn't help but put my 2 cents in...

That's a new one to me. In 16 years, I never had a plan say you can only have cerumen removal by a physician once every 90 days. Is the patient supposed to walk around unable to hear? What about if it was in a different ear?

Smells like an appeal to me but you will need to check for the policy for the patient's plan first if you are contracted (as Steve indicated).

Also, if the patient came in strictly for cerumen removal, the 99213 may not apply. The E&M should be seperate and distinct from the 69210 and usually requires a 25 modifier on the E&M.

April