Impacted cerumen. ICD-9-CM 380.4 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 380.4 should only be used for claims with a date of service on or before September 30, 2015.
Impacted cerumen, right ear 1 H61.21 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 The 2021 edition of ICD-10-CM H61.21 became effective on October 1, 2020. 3 This is the American ICD-10-CM version of H61.21 - other international versions of ICD-10 H61.21 may differ. More ...
Impacted cerumen, bilateral. H61.23 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2019 edition of ICD-10-CM H61.23 became effective on October 1, 2018. This is the American ICD-10-CM version of H61.23 - other international versions of ICD-10 H61.23 may differ.
The AMA’s CPT® Changes 2016: An Insider’s View confirms, “Impacted cerumen is typically extremely hard and dry and accompanied by pain and itching. Impacted cerumen obstructing the external auditory canal and tympanic membrane can lead to hearing loss.”
ICD-10-CM Code for Impacted cerumen, left ear H61. 22.
380.4 Impacted cerumen - ICD-9-CM Vol. 1 Diagnostic Codes.
ICD-10 code H61. 2 for Impacted cerumen is a medical classification as listed by WHO under the range - Diseases of the ear and mastoid process .
Cerumen impaction is defined as an accumulation of cerumen that causes symptoms or prevents assessment of the ear canal, tympanic membrane, or audiovestibular system; complete obstruction is not required.
Like CPT 69210, (removal of impacted cerumen requiring instrumentation, unilateral) 69209 requires that a physician or qualified healthcare professional make the decision to irrigate/lavage. However, unlike 69210, 69209 allows removal to be carried out by clinical staff.
A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Alternatively, the coder could report code 69210 twice with modifiers -LT (left side) and -RT (right side).
Removal impacted cerumen requiring instrumentation69210, Removal impacted cerumen requiring instrumentation, unilateral.
earwaxDefinition of cerumen : earwax. Other Words from cerumen Example Sentences Learn More About cerumen.
CPT code 69210, Removal impacted cerumen, (separate procedure) one or both ears.
Cerumen impaction is one of the most common reasons patients seek medical care for ear-related problems. Although excessive cerumen is present in 10 percent of children and more than 30 percent of older and cognitively impaired patients, cerumen impaction is underdiagnosed and likely undertreated.
Impacted cerumen removal is the extraction of hardened or accumulated cerumen (ear wax) from the external auditory canal by mechanical means, such as irrigation or debridement.
Cerumen is most likely to become impacted when it is pushed against the eardrum by these cotton-typed applicators, hairpins, or other objects that people put down their ear canals, and also by hearing aids. Less common causes of cerumen impaction include overproduction of earwax and an abnormally shaped ear canal.
– Question submitted by Kathy Partenheimer, Medical of DuboisA.In the July 2005 issue of CPT Assistant, the AMA clearly indicates that you should r...
A.For the purpose of accurate coding, the AMA defines “impacted cerumen” in the July 2005 CPT Assistant as follows:If any one or more of the follow...
A.A simplistic answer is that removing the wax is simply included in the emergency and management (E/M) code. The actual situation, however, is not...
A.Medicare accepts many different ICD-9 codes as “supporting medical necessity.” By definition, however,69210 always involves the diagnosis of impa...
Rather, most coders would recommend that code 69210 be reserved for use in situations where the cerumen removal takes significant effort by the physician. This is a situation where many individual payors have set different policies for application of this code, so it is best to check with individual payors for their policy.
Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.
As CMS cautioned in the Federal Register of June 29, 2006 (page 37233), “It is our understanding that CPT code 69210 is to be used when there is a substantial amount of cerumen in the external ear canal that is very difficult to remove and that impairs the patient’s auditory function. We will continue to monitor the use of this code for the appropriate circumstances.” To stay within the spirit of this definition, it seems best to avoid using this code for situations that only take a minute of the physician’s time to scoop out the wax. Rather, most coders would recommend that code 69210 be reserved for use in situations where the cerumen removal takes significant effort by the physician. This is a situation where many individual payors have set different policies for application of this code, so it is best to check with individual payors for their policy.
A.A simplistic answer is that removing the wax is simply included in the emergency and management (E/M) code . The actual situation, however, is not quite so straightforward.
By definition, however, 69210 always involves the diagnosis of impacted cerumen, so it seems reasonable to always attach the code for impacted cerumen ( 380.4) to the code 69210. Of course, the physician documentation should clearly demonstrate the presence of impacted cerumen, as defined above. If you are attempting to code an E/M code in addition ...
CPT defines cerumen as “impacted” if one or more of the following conditions are present: • cerumen impairs the examination of clinically significant portions of the external auditory canal, tympanic membrane (unable to see the entire tympanic membrane), or middle ear condition;
Payers typically will not cover simple, non-impacted earwax removal. This work is included in E/M services and should not be reported separately with E/M services when performed. If impacted earwax is removed by irrigation or lavage only, use CPT 69209. CPT 69210 should NOT be reported for lavage.
Note: Medicare does not allow the use of modifier 50 for impacted cerumen removal. To report to Medicare use unilateral code with no modifier whether performed unilaterally or bilaterally. Requirements for reporting impacted cerumen removal with an E/M on the same DOS.
CPT® guidelines tell us, “for cerumen removal that is not impacted, see E/M service code…” such new or established office patient (99201-99215), subsequent hospital care (99231-99233), etc. In other words: If the earwax isn’t impacted, removal is not separately billed and is included in the documented E/M service reported.#N#Per the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), earwax is impacted if one or more of the following conditions are present: 1 Cerumen impairs the examination of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition; 2 Extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc; 3 Cerumen is associated with foul odor, infection, or dermatitis; or 4 Obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician skills.
Note that both 69209 and 69210 are unilateral procedures; for removal of impacted wax from both ears, append modifier 50 Bilateral procedure to the appropriate code.
If earwax is impacted it may be removed by one of two general methods: Lavage (irrigation) or instrumentation. For removal by lavage, the correct code is 69209 Removal impacted cerumen using irrigation/lavage, unilateral.
In other words: If the earwax isn’t impacted, removal is not separately billed and is included in the documented E/M service reported. Per the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), earwax is impacted if one or more of the following conditions are present:
Finally, note that some payers may stipulate that “advanced practitioner skill” is necessary to report removal of impacted earwax (in other words, payers may require that a physician provide 69209, 69210). Query your individual payers to be certain of their requirements.
The 2022 edition of ICD-10-CM H61.23 became effective on October 1, 2021.
H61.23 is not usually sufficient justification for admission to an a cute care hospital when used a principal diagnosis. The following code (s) above H61.23 contain annotation back-references. Annotation Back-References. In this context, annotation back-references refer to codes that contain:
The 2022 edition of ICD-10-CM H61.21 became effective on October 1, 2021.
H61.21 is not usually sufficient justification for admission to an acute care hospital when used a principal diagnosis. The following code (s) above H61.21 contain annotation back-references. Annotation Back-References.