Primary Care Coding Alert

The article "Do You Need Instrumentation to Report 69210?" in the April Family Practice Coding Alert quoted a healthcare industry expert as saying Coders' Desk Reference contradicts CPT on 69210 (Removal impacted cerumen [separate procedure], one or both ears), but this is not the case.
 
Coders' Desk Reference, an Ingenix publication in its ninth edition, expands and clarifies the CPT description as follows: "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 then be irrigated." As stated, the Coders' Desk Reference description does not contradict the AMA's description of code 69210 but provides further detail.

This description is 100 percent accurate, says publisher Elizabeth Boudrie. Generally, most payers agree that 69210 should be reported when simple syringing does not remove impacted ear wax and instrumentation is required. Otherwise, a simple ear cleaning would be reported with an E/M code.

"Coders' Desk Reference is a trusted industry resource for clarification and amplification of the meaning of CPT codes," Boudrie says. "It is not meant, however, to address individual payer policies or wide variances in treatment protocols."