My carrier has a policy on this......
Modifier 25 and Ear Lavage
Q: Can an established patient visit and ear lavage be paid the same dos?
A: Ear lavage to remove ear wax would be considered part of an evaluation and management visit. Ear lavage may be done by either the physician or his/her staff. If a patient had impacted cerumen removed by the physician (e.g. via curettes) then CPT code 69210 could be billed. (Removing wax that is not impacted does not warrant the reporting of CPT code 69210)
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. For example, a visit on the same day could be properly billed in addition to irrigating the ears if, for example, a neurological assessment was medically necessary — i.e. done because the patient exhibited symptoms beyond those attributable to impacted cerumen: but, billing for a visit would not be appropriate if the physician only identified the need to remove the impacted cerumen. (See CMS Publication 100-4, the Claims Processing Manual, Chapter 12, section 40.1, subsection C via the attached link:
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