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.