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Thread: 69210 Cerumen Impaction

  1. #1

    Default 69210 Cerumen Impaction

    I was wondering if anyone could help me with the proper way to bill for a cerumen impaction. The code description says for 1 or 2 ears. If doctor does 2 ears, do I add 2 units, add mod 50 or is code 69210 just billed 1 time even if 2 ears are done? Any help would be greatly appreciated.
    Thanks
    Joni Kint

  2. #2

    Default

    Bill only one time.

    A major element in determining whether code 69210 should be reported is understanding the definition of impacted cerumen. By definition “ if any one of the following are present, cerumen should be considered impacted”:

    1. Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.
    2. Extremely hard, dry, irritative cerumen causing symptoms such as pain, itiching, hearing loss.
    3. Inflammatory conditions, infection or dermatitis
    4. Obstructive cerumen that cannot be removed without magnification and multiple instrumentation.

    Description of CPT 69210

    Under direct visualization, the physician removes impacted cerumen using suction, a cerumen spoon or delicate forceps, if no infection is present, the ear canal may be irrigated.

    A simple ear lavage, performed with water and bulb syringe, is considered inclusive with the office visit and is not to be billed.

    Appropriate coding of unscheduled, cerumen impaction removal along with Evaluation and Management:

    Example
    99213-25
    69210-59

  3. #3
    Join Date
    Apr 2007
    Location
    Alexandria Minnesota Chapter
    Posts
    50

    Default

    I would not use the 59 modifier on 69210, just the 25 modifier on the E/M, since this already states that it is a 'significant, separately identifiable E/M service.'

  4. #4
    Join Date
    Apr 2007
    Location
    North Carolina
    Posts
    3,127

    Default

    You don't need modifier 59. You're not trying to unbundle 69210 from 99213. Modifier 25 sufficiently indicates that 99213 is a separate, identifiable service.

  5. #5
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,072

    Default

    Quote Originally Posted by jkint View Post
    I was wondering if anyone could help me with the proper way to bill for a cerumen impaction. The code description says for 1 or 2 ears. If doctor does 2 ears, do I add 2 units, add mod 50 or is code 69210 just billed 1 time even if 2 ears are done? Any help would be greatly appreciated.
    Thanks
    Joni Kint
    The code states one or both ears so it does not matter whether you perform this procedure on one ear or both, think of it as the buy one get one philosphy! So to answer your question, no modifer and 1 unit of service regardless if perfomed on one or both.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6

    Default

    Agree, no -59

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