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69210 vs. ear irrigation only

  1. #1
    Question 69210 vs. ear irrigation only
    Medical Coding Books
    It is my understanding that if you are only irrigating a cerumen impaction that you would not code 69210 (under direct visualization, remove impacted cerumen using suction, cerumen spoon or delicate forceps. If no infection is present the ear canal may be irrigated). You would simply include the irrigation only in the E/M, taking a higher level if necessary and documented. Am I incorrect in my thinking? Can I get information somewhere to support this??

  2. #2
    My recommendation would be to review your local Medicare website on this code. Some states have LCD's, some do not. Commercial payers vary on what 69210 includes. For example, BCBS states irrigation is included in 69210. Others may differ. Basically, Medicare is scrutinizing this code and the documentation that supports it. Another good source of information is this website http://www.entnet.org. Simply put 69210 in the search engine & they outline the documentation that is necessary for this code.
    Good Luck!
    Evangelina Frohna, CPC, CEMC

  3. Default 69210
    You are correct, irrigation or lavage does not support coding 69210. We advise coding it only when the cerumen is impacted AND instrumentation is used, for example, a curette or forceps. Hope that helps.

  4. #4
    Duluth, Minnesota
    rarely, (and I do mean RARELY) does ear irrigation ever meet the actual requirements for the the 69210. At least at our facility and the one I was at before. Simply washing/irrigation of ear wax does not support it; and yes, I agree - you'd just include it in the E/M.
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  5. #5
    Overland Park, KS
    CPT Assisstant, July 2005 states that a simple lavage to remove impacted cerumen does not constitute billing 69210. The impacted cerumen has to be removed by a physician using instrumentation.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  6. #6
    here is some information from the CPT assistant that may assist you in your decision making in the future:

    Surgery: Auditory System

    In collaboration with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), we present the following discussion which provides some typical coding scenarios with regard to the appropriate use and application of CPT codes related to ear wax removal:

    1. The patient presents to the office for the removal of “ear wax” by the nurse via irrigation or lavage.

    2. The patient presents to the office for the removal of “ear wax” by the primary care physician via irrigation or lavage.

    3. The patient presents to the office for “ear wax” removal as the presenting complaint. This is described as impacted cerumen because it completely covers the eardrum and the patient has hearing loss. The impacted cerumen is removed by the primary care physician or otolaryngologist with magnification provided by an otoscope or operating microscope and instruments such as wax curettes, forceps, and suction.

    Question:Are these procedures appropriately reported with CPT code 69210, Removal impacted cerumen (separate procedure), one or both ears?

    AMA Comment: A major element in determining whether code 69210 should be reported is understanding the definition of impacted cerumen. By definition of the AAO-HNS, “If any one or more of the following are pre-sent, cerumen should be considered ‘impacted' clinically:

    Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.
    Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc.
    Inflammatory considerations: Associated with foul odor, infection, or dermatitis.
    Quantitative considerations: Obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations requiring physician skills.”
    Other issues may also require consideration. Removing wax that is not impacted does not warrant the reporting of CPT code 69210. Rather, that work would appropriately be captured by an evaluation and management (E/M) code regardless of how it is removed. If, however, the wax is truly impacted, then its removal should be reported with 69210 if performed by a physician using at minimum an otoscope and instruments such as wax curettes or, in the case of many otolaryngologists, with an operating microscope and suction plus specific ear instruments (eg, cup forceps, right angles). Accompanying documentation should indicate the time, effort, and equipment required to provide the service. Add-on code 69990, Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure), should not be reported if the operating microscope is used for cerumen removal. In this later instance, however, code 92504, Binocular microscopy (separate diagnostic procedure), may be reported.

    Therefore, based on this information, scenarios 1 and 2 would not be reported with code 69210. These scenarios would be captured by the appropriate E/M code. Scenario 3, however, should be reported with code 69210 because both criteria were met; the patient had cerumen impaction and the removal required physician work using at least an otoscope and instrumentation rather than simple lavage.

  7. #7
    Smile Thank you
    Thank you all so much for your responses and info - it is greatly appreciated. These forums are truly a great resource.

  8. Default auditor
    Is 69222 inclusive of 69210?

  9. #9
    Milwaukee WI
    Default 69222 and 69210
    Quote Originally Posted by thomas.white View Post
    Is 69222 inclusive of 69210?

    F Tessa Bartels, CPC, CEMC

  10. Default can you charge 69210 if cerumen was not removed?
    cerumen was impacted, provider used a currette but was unable to remove the cerumen, how is this charged?

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