Pediatric Coding Alert

Question: The Vol. 10, No. 5 Pediatric Coding Alert article "Greenlight 69210 Only When You Check Off 2 Items" indicates that I shouldn't report 69210 when the pediatrician uses ear lavage as the procedure to remove impacted cerumen.

However, the 2006 Coders' Desk Reference (CDR) for Procedures 69210 description states, "Under direct visualization, the physician removes impacted cerumen (ear wax) using suction, a cerumen spoon or delicate forceps. If no infection is present, the ear canal may be irrigated."
Doesn't the description's last sentence support irrigation as an appropriate means of removing impacted cerumen?


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Answer: Actually, the final sentence in the CDR's description of 69210 (Removal impacted cerumen, one or both ears) is an add-on describing work that could occur after the physician removes the impacted cerumen using instrumentation. The ear lavage would be used as an additional or final cleansing step.

Clinically, the American Academy of Otolaryngology--Head and Neck Surgery considers ear lavage alone indicative of wax removal, not impacted wax removal (380.4, Impacted cerumen). "If, however, the wax is truly impacted, then its removal should be reported with 69210 if performed by a physician using at minimum an otoscope and instruments such as wax curettes or, in the case of many otolaryngologists, with an operating microscope and suction plus specific ear instruments (e.g., cup forceps, right angles)," states the AMA in the July 2005 CPT Assistant. The AMA clearly indicates that you should report 69210 only when two criteria are met:

• "the patient had cerumen impaction" including blocking visualization of the tympanic membrane

• "and the removal required physician work using at least an otoscope and instrumentation rather than simple lavage" [emphasis added]. Example: The AMA illustrates the appropriate use of 69210 with the following scenario: The patient presents to the office for "ear wax" removal as the presenting complaint. Documentation describes this as impacted cerumen because it completely covers the eardrum and the patient has hearing loss. The primary-care physician removes the impacted cerumen with magnification provided by an otoscope or operating microscope and instruments such as wax curettes, forceps, and suction.