Primary Care Coding Alert

Choose an E/M instead if the cerumen is not impacted When the FP performs cerumen (earwax) removal on a patient, coders should resist the urge to choose the surgical removal code without considering the specifics of the encounter.

Why? Coders must look at each encounter separately in order to properly report 69210 (Removal impacted cerumen [separate procedure], one or both ears). Before choosing this code, you have to prove that the cerumen required instrumentation and physician involvement. For treatments that do not meet 69210 criteria, you-ll have to choose another coding strategy.

Check out this advice on when to pick 69210 -- and when to search for another coding option. Determine Whether Cerumen Is Impacted When considering 69210, you first need to find evidence that your physician removed impacted cerumen with instrumentation. If he removes the cerumen without instrumentation, you cannot report 69210.

-Impacted means the ear wax 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.

Also, the physician has to perform the procedure with some type of instrumentation to report 69210. On your 69210 claims, most carriers want to see evidence that the physician performed the disimpaction under direct visualization using one of the following methods:

 - suction

 - probes

 - right angle hooks

 - 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 irrigation or lavage, and involves a significant process,- Verno says. Your best bet is to check with your insurers for the specifics on their policies for 69210.

Example: A patient presents saying he has not been able to hear out of his right ear for the past four days; the patient also reports severe itching in the ear and a constant ringing. During the exam, the FP checks the ear canal and the middle of the left ear -- both are clear. But the FP cannot examine the right ear due to extreme blockage of the canal by crusty wax. Further, she cannot visualize the tympanic membrane due to blockage.

The FP removes a large piece of impacted cerumen using a curette and otoscope with large speculum. Upon re-examination of the right ear, the FP finds the blockage is clear, and the ear canal appears red and inflamed. The physician can now visualize the tympanic membrane, and the middle of the right ear is clear.

Solution: In this scenario, the physician satisfied the requirements for the cerumen removal code. Report 69210 for the procedure. Don't forget [...]