Code | Description |
---|---|
69209 | REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL |
69210 | REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL |
G0268 | REMOVAL OF IMPACTED CERUMEN (ONE OR BOTH EARS) BY PHYSICIAN ON SAME DATE OF SERVICE AS AUDIOLOGIC FUNCTION TESTING |
1. Cerumen impairs the exam of clinically significant portions of the external auditory canal, tympanic member, or middle ear condition;
41010: Incision of lingual frenum (frenotomy): The physician makes an incision in the lingual frenum, freeing the tongue and allower greater range of motion. The lingual frenum is the membrane under the tongue that attaches it to the floor of the mouth.
40806: Incision of labi al frenum (frenotomy): The physician makes an incision in the labial frenum, freeing the lip and allower greater range of motion. The labial frenum is the membrane that attaches the lip to the gums.
3. Obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician skills. (but check for payer policy because some allow you to bill for an MA doing a warm water irrigation)
You don't. Cerumen presence is a normal state. Think of it like this... you don't diagnose "breathing".
This code is not used with minor procedures, or when it is not used for a diagnostic procedure. Cerumen removal and binocular microscopy are bundled with each other.
CPT® guidelines tell us, “For cerumen removal that is not impacted, see E/M service code …” such as new or established office patient (99201-99215), subsequent hospital care (99231-99233), etc. In other words: If the earwax isn’t impacted, removal is included in the documented evaluation and management (E/M) service reported and may not be separately billed.#N#Per the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), cerumen 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.
Code 69210 only captures the direct method of earwax removal utilizing curettes, hooks, forceps, and suction. Another less invasive method uses a continuous low pressure flow of liquid (eg, saline water) to gently loosen impacted cerumen and flush it out … Code 69209 enables the irrigation or lavage method of impacted cerumen removal to be separately reported…
Both 69209 and 69210 are unilateral procedures . For removal of impacted earwax from both ears, append modifier 50 Bilateral procedure to the appropriate code. In the example above of the 7-year-old child, if irrigation occurred in both ears, appropriate coding is 69209-50.#N#When billing Medicare payers, different bilateral rules apply for 69210. The 2016 Medicare National Physician Fee Schedule Relative Value File assigns 69210 a “2” bilateral indicator. This means, for Medicare payers, the relative value units assigned to 69210 “are already based on the procedure being performed as a bilateral procedure.” In contrast to CPT® instructions, the Centers for Medicare & Medicaid Services (CMS) allows us to report only one unit of 69210 for a bilateral procedure. CMS does allow us to bill a bilateral procedure for cerumen removal by lavage using 69209-50.#N#Finally, note that some payers may stipulate “advanced practitioner skill” is necessary to report removal of impacted earwax (i.e., payers may require that a physician provide 69209, 69210). Query your individual payers to be certain of their requirements.
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.”