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Thread: Ear Lavage coding

  1. #1

    Default Ear Lavage coding

    I'm curious what others think about coding 69210 for ear lavage when the doctor documents that the wax was impacted, but the ear only needed to be lavaged (no other instruments were used)? I'm curious whether a syringe should be considered instrumentation (as described in the CPT Assistant)?
    thank you

  2. #2
    Join Date
    Apr 2007
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    Stuart Sailfish Chapter
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    845

    Default

    Removal of impacted wax typically requires the use of an otoscope as well as other instruments including wax curettes, forceps, right angles and suction.
    I work for an ENT and typically we get the patients that come in from their PCP after a Lavage.

    I am almost certain that lavage would be billed as part of the E/M.
    Curious to see other responses
    Candice Fenildo, CPC, CPMA, CPB, CENTC, CPC-I
    AAPC Chapter Association Board of Directors ( Chair)
    Region 6, Wisconsin, Minnesota, Illinois, Indiana, Michigan, Ohio
    772-342-6976
    Candice.Fenildo@appcca.org

    "Nothing is stronger than the heart of a volunteer"

  3. #3
    Join Date
    Apr 2007
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    19

    Default ear lavage

    I agree that the use of an otoscope and/or forceps or other instrument needs to be used in order to bill for the removal. We typically consider the lavage part of the E/M service.

    Becky Zellmer, CPC, MBS, CBCS
    Provider Education
    Prevea Health

  4. #4
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    Apr 2007
    Location
    Columbus, OH
    Posts
    212

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    This would not be separately billable and would be included in the E/M service provided. Code 69210 should not be used to report an irrigation or lavage done by either a nurse or a physician. The 69210 should only be used when, 1. the patient has a cerumen impaction (380.4) and 2. the removal requires physician work using at least an otoscope and instrumentation, rather than simple lavage. Instrumentation can be wax curettes, forceps and suction. Documentation: you should have a separate entry from the physician to support the procedure. Accompanying documentation should indicate the time, effort, and equipment required to provide the service. This information was obtained via The Coding Institute November, 2005 Internal Medicine Coding Alert. Hope this helps. I have the article if this would be helpful, just let me know.
    ___________________________________
    Michelle Wood, RHIT, CCS-P, CPC, CPMA, CEMC
    2016 AAPC Columbus, Ohio Chapter President
    mrs.snail@yahoo.com

  5. #5

    Default

    I agree with the others and CPC Assistant from 7/2005 also supports this position. An ear wash squeegy is not an instrument.

  6. #6
    Join Date
    Apr 2007
    Posts
    24

    Default

    Quote Originally Posted by mrssnail View Post
    This would not be separately billable and would be included in the E/M service provided. Code 69210 should not be used to report an irrigation or lavage done by either a nurse or a physician. The 69210 should only be used when, 1. the patient has a cerumen impaction (380.4) and 2. the removal requires physician work using at least an otoscope and instrumentation, rather than simple lavage. Instrumentation can be wax curettes, forceps and suction. Documentation: you should have a separate entry from the physician to support the procedure. Accompanying documentation should indicate the time, effort, and equipment required to provide the service. This information was obtained via The Coding Institute November, 2005 Internal Medicine Coding Alert. Hope this helps. I have the article if this would be helpful, just let me know.
    could you please send me a copy of the article? our nurses our doing our ear flushes with syringes only,and most of the docs do not get involved. i saw int the coding edge this month that the provider is the one that needs to do the work, but i need something solid in writing to bring to my manager. any light you can shed on this for me would be appreciated.
    Barbara.Suse@vrh.org thanks!

  7. #7

    Default

    I recently did an audit of a group of my providers who submitted 200 encounters which included the CPT code 69210. Three encounters out of the 200 supported the CPT code 69210. The rest were "ear flushes" done by a LPN. The three encounters that did support CPT code 69210 documented that the ear was impacted and a currette was used by a physician. Refunds will be made going back six years and education will be provided to the providers.

    Respectfully,

    Barbara A. Love, CPC, CPC-H, CMSCS, CBCS

  8. #8

    Default

    Mrssnail

    Please send me a copy of the Nov 2005 Coding Institute, in regards to code 69210...thank you..
    Valerie
    Valdenise38@yahoo.com

  9. #9

    Default

    can i get a copy too? jazelbagsic@gmail.com

  10. #10

    Default

    Please send me a copy of the 2005 publication on ear lavage in conjunction with an office visit. I'm performing an audit and need this information for support. Thanks very much for your response.

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