Coding Cerumen Removal
The CPT(R) guidelines states ?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. which means 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:
- Cerumen impairs the examination of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition;
- Extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc;
- Cerumen is associated with foul odor, infection, or dermatitis; or
- Obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician skills.
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.
- For removal using instrumentation (e.g., forceps, curette, etc.), turn instead to 69210 Removal impacted cerumen requiring instrumentation, unilateral.
It must be noted that both 69209 and 69210 are unilateral procedures; for removal of impacted wax from both ears, modifier 50 Bilateral procedure to the appropriate code must be appended.
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.
For Medicare payers, the relative value units assigned to 69210 ?are already based on the procedure being performed as a bilateral procedure.?
Lastly it should be noted that some payers may stipulate that ?advanced practitioner skill? is necessary to report removal of impacted earwax (payers may require that a physician provide 69209, 69210). It may be necessary at times to query individual payers to be certain of their requirements.