Primary Care Coding Alert

Careful: That cerumen removal encounter might be an E/M When your FP removes cerumen, zoom in on the instrumentation and diagnosis to ethically boost practice revenue. Suppose your FP provides 69210 (Removal of impacted cerumen [separate procedure], one or both ears), but you report 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...). In 2008, 69210 pays about $45 nationally -- compared with about $37 for 99212. That $8 may not seem like much, but over a year it can add up. Check out this primer on identifying impacted cerumen claims. Verify Cerumen Is Impacted The key to proper code choice for cerumen removal lies with the diagnosis and the physician's actions. If the FP removes impacted cerumen with instrumentation, you can report 69210 for the service, says Kent Moore, manager of healthcare financing and delivery systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan. If the physician (or a nonphysician practitioner) removes the cerumen with lavages or other solutions, you cannot use 69210. "Impacted" definition: For coding purposes, "impacted" cerumen is "packed tightly in the outer ear, so much so that the external ear canal is blocked. The ear wax is hard and possibly crusted," says Steve Verno, NREMTP, CMBSI, director of reimbursement at EMS in Hollywood, Fla. Impacted cerumen may block the patient's tympanic membrane or cause hearing loss, Verno says. Let Instrumentation Guide You to Proper Code According to Moore, if your FP uses one of the following instruments to remove 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 removal is performed by means other than simple lavage and involves a significant process," Verno says. As an example, Verno notes the 69210 policy for Blue Cross-Blue Shield: "CPT code 69210 is eligible for reimbursement when the following criteria are met: The cerumen removal requires the skill of a physician, or the removal is directly supervised by a physician and the removal requires a significant amount of time and effort." Example: An established patient presents with problems in his right ear. He says there's been constant ringing in the ear and severe itching in the canal for the past three days. The FP checks the patient's left ear, which is clear. A right-ear check reveals extreme blockage of canal by crusty hard wax. Due to the obstruction, the FP cannot see the tympanic membrane. The FP removes a large piece of impacted cerumen using an ear [...]