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Wiki Modifying 25 Cerumen Impaction.
- Thread starter MCotton83
- Start date
RebeccaWoodward*
True Blue
Typically, an ear lavage is inclusive to the office visit. When my phyisicians have questions about this...I always print them a copy of the AMA guidelines (already on another thread from this site)
https://www.aapc.com/MemberArea/forums/showthread.php?p=24392
https://www.aapc.com/MemberArea/forums/showthread.php?p=24392
RebeccaWoodward*
True Blue
Gotcha...In that case, Yes. Modifier 25 goes on the E/M. 
Coding82
New
what if a RX was not given?
RebeccaWoodward*
True Blue
Ok...let me back up.
If the physician removes impacted cerumen with instrumentation, you can report 69210 for the service. If the physician/NPP removes the cerumen with lavages or other solutions, personally, I wouldn't report 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"
As far as billing an E&M visit in addition to removal of impacted cerumen, visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. With that being said, I personally don't feel that a RX is the winning factor that determines billing 69210 and an E/M. If there is a significant, separately identifiable service performed in addition to 69210 and documentation supports both, you have a billable claim.
If the physician removes impacted cerumen with instrumentation, you can report 69210 for the service. If the physician/NPP removes the cerumen with lavages or other solutions, personally, I wouldn't report 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"
As far as billing an E&M visit in addition to removal of impacted cerumen, visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. With that being said, I personally don't feel that a RX is the winning factor that determines billing 69210 and an E/M. If there is a significant, separately identifiable service performed in addition to 69210 and documentation supports both, you have a billable claim.