You are correct. Ear lavage is bundled into the E/M service.
There is a code 69209 for removal of impacted cerumen using irrigation/lavage, unilateral; however, the parenthetical notes in CPT specifically state: "For cerumen removal that is not impacted, see E/M service code." It is easily inferred that a simple lavage of infected material would also be bundled into the E/M service. From a coding perspective, the removal of infected material is no different than removal of non-impacted cerumen. You can always provide your physician with the article from the CPT Assistant, October 2013:
CPT Assistant Archives - Coding Update: Auditory System (69210) (October 2013, page 14)
Auditory System code 69210, Removal impacted cerumen requiring instrumentation, unilateral, is revised in the Current Procedural Terminology (CPT®) 2014 code set to include the use of instrumentation in the removal of impacted cerumen (ear wax) and to clarify that the procedure is unilateral. In collaboration with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), this article discusses the following three coding scenarios related to ear wax removal and the appropriate CPT codes to report once the 2014 revisions become effective:
- The patient presents to the office for the removal of ear wax by the nurse via irrigation or lavage.
- The patient presents to the office for the removal of ear wax by a physician (any specialty) via irrigation or lavage.
- The patient presents to the office for ear wax removal which requires magnification provided by an otoscope or operating microscope, and instruments such as wax curettes, forceps, or suction by the primary care physician or otolaryngologist.
This latter situation occurs most commonly when impacted cerumen completely covers the eardrum and the patient has hearing loss.
Question: Are all of these procedures appropriately reported with CPT code 69210, Removal impacted cerumen requiring instrumentation, unilateral?
Answer: No. Only the third scenario listed above would be reported with CPT code 69210.
Other issues may also require consideration. Removing wax that is not impacted does not warrant the reporting of code 69210. Rather, that work would appropriately be reported with an evaluation and management (E/M) code regardless of how it is removed (eg, lavage, irrigation, etc). Therefore, based on this information, scenarios 1 and 2 would not be reported with code 69210. These scenarios would be reported with the appropriate E/M code. Scenario 3, however, would be reported with code 69210 because both criteria were met: the patient had cerumen impaction and the removal required physician work using an otoscope or other magnification and instrumentation, rather than simple lavage.
I hope that helps!
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