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Thread: Removal of impacted cerumen

  1. #11
    Join Date
    Apr 2007
    Duluth, Minnesota


    AAPC: Back to School
    I'm wanted to comment on the flu vaccine given -
    81 year old, (I'm assuming she's on Medicare) the administration code for the flu vaccine should be G0008 (not 90472) .
    that being said, ... even if she wasn't on Medicare - why do you have a 90472? - shouldn't it be a 90471 (non medicare). I don't see any other vaccine given - just the flu - (unless I missed it) so why would you use the "each additional" code for the administration of it?
    just curious...

    oh, and I will say - I wouldn't be billing/charging out the cerumen removal - to me, the documentation does not support it. appears to be irrigation to me.
    {just my opinion}
    Donna, CPC, CPC-H

  2. #12



    If this EMR is like some I'm familiar with, hehe, it depends on how the CPT's are set up in the system as to what's available to the provider. Even if it goes into the 'billing cycle', it probably get's edited by a biller or coder who makes the appropriate changes.

    Good eye on that one! We all need to keep on our toes and not completely rely on EMR for codes.

  3. #13
    Join Date
    Apr 2007
    Temple, TX


    The simplest way it was explained to me, that to compare an ear irrigation with rinsing of a skin wound. You are not able to bill that as a procedure either.
    Your note states irrigation only, so it would be no.
    It took me some frustration to get over this, but if you look at it as flushing a wound it kind of makes sense.
    The provider has to use tool to remove the impacte cerumen.
    The Oracle

  4. #14


    Just to make sure, ear lavage by nurse only is not to be billed?



  5. #15


    It is my understanding that ear lavage by anyone is not billed, it is included in the E/M. Instruments must be used for cerumen impaction removal in order to bill it and it must be done by the physician, etc. We also require that the time it took for the procedure to be done is documented as well.

  6. #16
    Join Date
    Apr 2007
    Greeley, Colorado


    Another point, you can't bill Medicare for surgical supplies/trays.
    Lisa Bledsoe, CPC, CPMA

  7. #17


    Also note, Medicare only pays 69210 one time per year; documentation must indicate that the wax was impacted, time involved, etc... simply removing wax with a currette does not constitute impacted wax removal, most of the time microscopy is involved due to the difficulty of the procedure. I am not sure of what type of "surgical tray" would be required with wax removal but it is not a reimburseable item unless you list everything you use on the tray.

    ENT - CT

  8. #18



    Perhaps 69210 being covered only once per year is per the specific Medicare carrier.

    In Michigan, we do not have a frequency limitation on cerumen impaction removal. 69210 is covered as much as needed.

  9. #19
    Join Date
    Apr 2007
    Pensacola, FL


    Thank you all. I have talked with the providers to explain everything. Also to comment, I do know that Medicare will not pay for the supplies and I know that the note reflects 90472 - that was a mistake on the PA's imput which I did correct before it was billed out. I have to double check everything before it gets sent out because we are on EMR and the codes plugged into the patient's note is not always the right one.

    Thank you all!

    Kristie Stokes, CPC, AIHC ICDCT-CM

    AAPCCA Board of Directors 2014-2017
    Region 1 - Northeast
    Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York

    Today, give a stranger one of your smiles. It might be the only sunshine they see all day.

  10. #20


    When the procedure is done by the doctor, with the instrument, can he bill the e/m service (with 25 modifier) and the 69210, using the same ICD code?

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