ED Coding and Reimbursement Alert

Question: How should I report cerumen removal, and can I ever report a separate evaluation and management service as well for a Medicare patient?

Ohio Subscriber Answer: You should report cerumen removal with 69210 (Removal impacted cerumen [separate procedure], one or both ears). You can code a separate E/M service when reporting to Medicare only if the patient receives a significant, separately identifiable service.

Keep in mind that the encounter must meet four  conditions to earn reimbursement:

presence of impacted cerumen;
a medically necessary removal;
cerumen removal performed by the physician or a nonphysician practitioner; and
significant effort required for removal. Certain situations could support reporting a separately identifiable E/M service, such as a patient who presents with decreased hearing or dizziness, for whom the physician performs a thorough neurological exam. If you do report a separate E/M service, be sure your operative notes reflect such a condition. Also, remember to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

Ask yourself why the patient came into the emergency department: for cerumen removal or for a different ailment. If your documentation proves that a different ailment was the primary reason for the visit, Medicare may reimburse for the E/M service.