EM in the ER


Spokane, WA
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I agree with Rachel as long as the documentation shows that 69210 is a significant, separately identifiable procedure and procedure is fully documented.
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I just read the following info:

Coding cerumen removal

Q Recently, I was told that the appropriate use of CPT code 69210, "Removal impacted cerumen (separate procedure), one or both ears," requires direct visualization by the physician and removal using suction, a cerumen spoon or delicate forceps. However, my understanding of 69210 has always been more liberal than this, including removal using irrigation or chemical solvents that may be done by a physician or by ancillary staff incident-to a physician's service. Which is the correct interpretation of this code?

A It depends on the payer. Because CPT does not specify what the term "removal" refers to with this code, removal by any means would qualify from a CPT perspective. Assuming Medicare's "incident-to" rules are met, you should also be able to code this as incident-to a physician's service in some cases. (For more information on "incident-to" reimbursement, see "The Ins and Outs of "Incident-To" Reimbursement," FPM, November/December 2001, page 23.)

However, according to CMS, payment for cerumen removal is made only when the following criteria are met:

1. The service is the sole reason for the patient encounter;

2. The service is personally performed by a physician or non-physician (NP, PA, CNS);

3. The service is provided to a patient who is symptomatic;

4. The documentation illustrates significant time and effort spent performing the service.

CMS also defines routine cerumen removal as the use of softening drops, cotton swaps and/or cerumen spoon and is not paid separately since it is considered incidental to the office visit.

These criteria may also be true for some commercial payers. Check with your individual payers to determine their policies.