Wiki 69210 vs. ear irrigation only

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More
C
69210 vs. Ear Irrigation Only

Report 69210 Removal impacted cerumen requiring instrumentation, unilateral if instrumentation is used to remove impacted cerumen. Impacted cerumen is typically extremely hard and dry, usually is accompanied by pain and itching, and can lead to hearing loss.

Code 69210 captures the direct method of impacted earwax removal using curettes, hooks, forceps, and suction. CPT® considers this procedure to be unilateral. CPT® states, “For bilateral procedure, report 69210 with modifier 50.” Medicare will pay the same amount for 69210 whether it is performed on one ear or two, even though the CPT® descriptor stipulates it is unilateral.

CPT® 69209 Removal impacted cerumen using irrigation/lavage, unilateral reports removal of impacted cerumen (earwax) by irrigation and/or lavage. This method is less invasive than 69210: a continuous low pressure flow of liquid (e.g., saline solution) is used to gently loosen impacted cerumen and flush it out, with or without the use of a cerumen softening agent (e.g., cerumenolytic) that may be administered days prior to, or at the time of, the procedure. This is considered an indirect method of cerumen removal and is reported when the removal of impacted cerumen does not require instrumentation.

Only one method of removal of impacted cerumen (i.e., either 69209 or 69210) may be reported when both are performed on the same day on the same ear. Procedure code 69209 is unilateral. If performed bilaterally, report 69209 on a single claim detail line with the modifier 50 appended. As stated above, individual payers may have different rules on billing unilateral procedures performed bilaterally and may prefer that the procedure codes be billed as separate line items with RT and LT modifiers for right and left, respectively.

Per CPT® Assistant (March 2016), “For the removal of cerumen that is not impacted, report the appropriate evaluation and management (E/M) service code (eg, 99201-99215, 99221-99223).”

For additional information about coding for 69209, 69210, see also the January 2016 CPT® Assistant.

lphillips

Guru
Messages
108
Location
Anchorage, AK
Best answers
0
It is my understanding that if you are only irrigating a cerumen impaction that you would not code 69210 (under direct visualization, remove impacted cerumen using suction, cerumen spoon or delicate forceps. If no infection is present the ear canal may be irrigated). You would simply include the irrigation only in the E/M, taking a higher level if necessary and documented. Am I incorrect in my thinking? Can I get information somewhere to support this??
 

MBlack

New
Messages
2
Best answers
0
69210

You are correct, irrigation or lavage does not support coding 69210. We advise coding it only when the cerumen is impacted AND instrumentation is used, for example, a curette or forceps. Hope that helps.
 

dmaec

True Blue
Messages
1,133
Location
Duluth, Minnesota
Best answers
0
rarely, (and I do mean RARELY) does ear irrigation ever meet the actual requirements for the the 69210. At least at our facility and the one I was at before. Simply washing/irrigation of ear wax does not support it; and yes, I agree - you'd just include it in the E/M.
{that's my opinion on the posted matter}
 

dballard2004

True Blue
Messages
1,168
Location
Gower, MO
Best answers
0
CPT Assisstant, July 2005 states that a simple lavage to remove impacted cerumen does not constitute billing 69210. The impacted cerumen has to be removed by a physician using instrumentation.
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
Best answers
0
here is some information from the CPT assistant that may assist you in your decision making in the future:

Surgery: Auditory System

In collaboration with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), we present the following discussion which provides some typical coding scenarios with regard to the appropriate use and application of CPT codes related to ear wax removal:

1. The patient presents to the office for the removal of “ear wax” by the nurse via irrigation or lavage.

2. The patient presents to the office for the removal of “ear wax” by the primary care physician via irrigation or lavage.

3. The patient presents to the office for “ear wax” removal as the presenting complaint. This is described as impacted cerumen because it completely covers the eardrum and the patient has hearing loss. The impacted cerumen is removed by the primary care physician or otolaryngologist with magnification provided by an otoscope or operating microscope and instruments such as wax curettes, forceps, and suction.

Question:Are these procedures appropriately reported with CPT code 69210, Removal impacted cerumen (separate procedure), one or both ears?

AMA Comment: A major element in determining whether code 69210 should be reported is understanding the definition of impacted cerumen. By definition of the AAO-HNS, “If any one or more of the following are pre-sent, cerumen should be considered ‘impacted' clinically:

Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.
Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc.
Inflammatory considerations: Associated with foul odor, infection, or dermatitis.
Quantitative considerations: Obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations requiring physician skills.”
Other issues may also require consideration. Removing wax that is not impacted does not warrant the reporting of CPT code 69210. Rather, that work would appropriately be captured by an evaluation and management (E/M) code regardless of how it is removed. 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 (eg, cup forceps, right angles). Accompanying documentation should indicate the time, effort, and equipment required to provide the service. Add-on code 69990, Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure), should not be reported if the operating microscope is used for cerumen removal. In this later instance, however, code 92504, Binocular microscopy (separate diagnostic procedure), may be reported.

Therefore, based on this information, scenarios 1 and 2 would not be reported with code 69210. These scenarios would be captured by the appropriate E/M code. Scenario 3, however, should be reported with code 69210 because both criteria were met; the patient had cerumen impaction and the removal required physician work using at least an otoscope and instrumentation rather than simple lavage.

 

lphillips

Guru
Messages
108
Location
Anchorage, AK
Best answers
0
Thank you

Thank you all so much for your responses and info - it is greatly appreciated. These forums are truly a great resource.
 

wturner1

Guest
Messages
2
Best answers
0
can you charge 69210 if cerumen was not removed?

cerumen was impacted, provider used a currette but was unable to remove the cerumen, how is this charged?
 

tovygoldstein

Networker
Messages
79
Best answers
0
The 2014 CPT book's description for 69210 is "Removal impacted cerumen requiring instrumentation, unilateral"

then -

"Excludes Removal of cerumen by irrigation only (see appropriate E/M code(s))"
 
Messages
1
Best answers
0
If the provider performs ear irrigation and uses instrument to remove wax that is still in the ear (not impacted now, just residual from irrigation), which code is appropriate? If the provider only states instrument but doesn't state the type of instrument, what should be billed?
 
Top