Otolaryngology Coding Alert

Question: A patient has crusting in the ear canal and/or around the drum. What is the proper coding?

Anonymous WA Coder

Answer: The ear is viewed by the physician with an otoscope. Under direct visualization the physician removes cerumen with a cerumen spoon. If there is no infection the physician can then irrigate the ear canal using an ear irrigator or a simple water pik, says Teresa Burnett, CPC, an otolaryngology coder at the Clark-Holder Clinic in LaGrange, GA. The correct CPT code is 69210 (removal of cerumen), with ICD-9 code 380.4 (impacted cerumen). There are no codes for general irrigation and cleaning out of the ear canal, both of which are considered components of an E/M service performed.

Gretchen Segado, CPC, of Jefferson Otolaryngology in Philadelphia, PA, notes that if the physician performs a hearing test, the 69210 will be denied because, according to HCFAs Correct Coding Initiative, cerumen removal is bundled into the hearing test, despite the fact that it can take as long as 30 minutes to clean the ear using sophisticated equipment. Segado says some commercial carriers do pay for the procedure.
If the physician truly feels that the amount of time taken to clean the earwax out was excessive or that the procedure was complicated, then he or she should append a -22 modifier (unusual services) to the E/M code. This would require submission of very specific documentation to support the additional work level claimed. Responses to such claims vary.