ED Coding and Reimbursement Alert

Here's why that removal might be an E/M Patients who require cerumen (earwax) removal can clog up your coding continuity if you-re not careful to identify the type of cerumen the physician treats. When an ED provider removes non-impacted cerumen, you should consider the removal an E/M service. On the other hand, if the provider removes impacted cerumen, you will likely choose a CPT code instead. Check out this primer on identifying impacted cerumen claims. Make Sure Cerumen Is Impacted The key to proper code choice for cerumen removal lies with the diagnosis and the provider's actions during the encounter. If the physician removes impacted cerumen with instrumentation, you can report 69210 (Removal impacted cerumen [separate procedure], one or both ears) for the service, says Sandra Pinckney, CPC, coder at Certified Emergency Medicine Specialists PC in Grand Rapids, Mich. "Impacted" definition: For coding purposes, "impacted" cerumen is earwax that "impairs the exam of a clinically significant portion of an external auditory canal, tympanic membrane or middle ear condition," says Jamie Darling, CPC, coder at EA Health Corp. in Solana Beach, Calif. This cerumen is usually extremely hard and dry, and often causes the patient pain or itching. It may also have a foul odor or cause infection, Darling says. "So we aren't talking about the kind of earwax a nurse can flush out easily prior to an exam," Darling says. Instrumentation Can Guide You to Proper Code According to Pinckney, if the physician uses one of the following instruments to remove impacted cerumen, the service likely qualifies for 69210: - suction - probes - forceps - right angle hooks - wax curettes. You should use these criteria as a base, but different carriers may have different policies on cerumen removal. The commonality is that the ear is impacted with cerumen and the provider performs removal by means other than simple lavage, involving a significant process. You-ll also have to prove medical necessity and include the proper documentation for your 69210 claim to be successful, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. Falbo offers this guidance from Pennsylvania Medicare. According to the carrier, payment for removal of impacted cerumen is allowable when the encounter meets the following conditions: - the service is the sole reason for the patient encounter, - the service is performed by a physician or non-physician practitioner (i.e., nurse practitioner, physician assistant, clinical nurse specialist), - the provider shows that the patient has impacted cerumen symptoms, and - the documentation illustrates significant time and effort spent in performing the service. Example: A patient presents with problems in his right ear. He says there has been constant ringing in the ear and [...]