The correct way to remove impacted earwax that worked for. Dec 17, 2015 that said, it is never appropriate to report 69990 with 69210 because 69990 is meant for microsurgical techniquesmicrodissection. Although devices may be recommended in some circumstances, they are not always necessary or the right answer to solve hearing problems. Cerumen removal law and legal definition uslegal, inc. Family medicine residency program dr nelson, rush medical college. This procedure allows an rn to assess the amount of cerumen in the ear canal and to initiate the process of clearing the ear canal when the rn or clinician assesses excess cerumen. A new cerumen impaction code was revealed at the annual cpt ama symposium. If documentation indicates that the patient had cerumen impaction and the removal required physician work and instrumentation such as wax.
Cpt 99392, 69210, 69209 cerumen removal medical billing. Removal of the impacted cerumen requires the expertise of the physician or npp and is personally performed by him or her. Request a signed advance beneficiary notice in these cases, as you will probably be denied for all or part of the charge. Removal of impacted cerumen requiring instrumentation effective date. Cerumen or earwax should not be removed by using cotton ear buds, ear swabs, fingers or any other sharp devices, when excessive wax clogs the ear canal. I enjoyed your article on the new cerumen removal code 69209 removal impacted cerumen using irrigationlavage, unilateral pediatric coding alert vol. This response is based on the best information available as of 121715. Cerumen impaction is a condition in which earwax has become tightly packed.
Cerumen typically clears itself from the ears, but in some instances can accumulate and cause a blockage. Feb 11, 2014 medicare turns deaf ear to cpt changes on cerumen removal medicare payment policy doesnt always match the american medical associations current procedural terminology cpt. Medicare turns deaf ear to cpt changes on cerumen removal fpm. However, despite being one of the most common reasons for an ear, nose, and throat ent patient encounter, cerumen removal remains one of the most miscoded areas of the specialty. The routine removal of asymptomatic, nonimpacted, nonobstructive cerumen does not generally require a physicians skill and is thus not. This paper describes the knowledge and skills required to perform cerumen management safely and effectively. The purpose of this article is to clarify claim submission instructions when this service is performed bilaterally. Bcbsks policy continues to consider 69210 as content of an evaluation and management em. Documentation of impaction is critical in determining how you will code the evaluation and management em encounter. We are reporting cpt code 69209 removal impacted cerumen using irrigationlavage, unilateral for each ear, and the documentation supports the irrigationlavage rather than the physician removing the impaction with instruments. Cerumen, also known as earwax, is naturally produced by the glands in the ears to lubricate the ear canals and keep dust and debris from getting too far down in the ear canal.
Patients presenting with earwax impaction need access to earwax removal services in primary care. In fact, the american family physician website tells us that cerumen removal is the most common ear, nose, and throat ent procedure performed in primary care. Jul 27, 2015 analysis of the 2015 medicare physician fee schedule mpfs, including. Coding for cerumen removal aap pediatric coding newsletter. It is important to use oil softening or irrigation technique to remove the earwax. Send revised claims andor additional documentation immediately upon receipt of a denial. The academys coding corner makes accessing the newest coding and reimbursement tools simple and straightforward for members. Cerumen removal emergency medicine procedures and references.
If you decide you do not want to have your wax removed at any time, you may stop the procedure. Cerumen typically clears itself from the ears, but in some instances, it can accumulate and cause a blockage. This is how the visit reads and im not short cutting it, the actual documentation is this short. Coding challenges in internal medicine presented by. Abrasions to the ear canal may occur during cerumen removal. We have started receiving rejections for ed claims when the services involves removing impacted cerumen. Ama cpt code set revision process, ama ruc process, and aaohns new. To get set up for eft, fill out and submit the electronic remittance form. Mar 01, 2016 cerumen ear wax can build up in the ear canal, which may lead to symptoms of discomfort, dizziness, and impaired hearing for which patients seek medical care.
Roesert abstract cerumen management is now within the scope of practice for audiologists. Cerumen removal emergency medicine reference information brought to you by procedures consult. Coding for removal of impacted cerumen 69210 journal. Check with your state to ensure cerumen removal is within your scope of practice inform your clinic that you plan on performing cerumen removal follow the universal precautions contained in the cdc for bloodborne pathogens gloves, masks as needed ensure your liability insurance covers cerumen removal. During cerumen removal, the licensee shall comply with the principles of universal precautions. If the patient underwent impacted cerumen removal from both ears, youd need to append modifier 50 with a 1 in the unit field, according to paramount. Cerumen typically clears itself from the ears, but in some instances can accumulate and cause a blockage, especially if you wear earmolds or hearing aids. Before the removal of cerumen, the licensee shall obtain the informed consent of the patient, or legally responsible adult, and maintain documentation. See below for the latest resources specific to the specialty.
You may bill code 69210, removal impacted cerumen requiring instrumentation, unilateral, with modifier 50 added to indicate that the procedure was performed bilaterally, but the medicare. Calm ear now called proear, dropped in the ear canal, softens the cerumen ear wax so it quickly slips off the canal wall. A fundamental but neglected problem by pediatricians. In addition, the payment update for 2016 and each subsequent year through 2019 will also be medicare payment, and audiology payment and coding rules. If the cerumen is impacted, the method used to remove it. Cerumen ear wax can build up in the ear canal, which may lead to symptoms of discomfort, dizziness, and impaired hearing for which patients seek medical care. A few may need manual disimpaction under direct vision using suction. The knowledge and skills asha recommends that audiologists have prior to performing cerumen management focus on oto. Cerumen removal can only be performed by a licensed audiologist.
Sometimes, fluid, infection, wax or other more serious medical conditions can play a role in hearing loss. Procedure the patient may be pretreated with a solution to soften cerumen prior to the procedure. This product includes cpt which is commercial technical data andor computer data bases andor commercial computer software andor commercial computer software documentation, as applicable which were developed exclusively at private expense by the american medical association, 515 north state street, chicago, illinois, 60610. Medicare turns deaf ear to cpt changes on cerumen removal medicare payment policy doesnt always match the american medical associations current procedural terminology cpt. There are many reasons why your hearing may not be optimal. Pg0005 impacted cerumen removal paramount health care. As is clearly stated in their official descriptors, cpt codes 69209 and 69210 removal impacted cerumen requiring instrumentation, unilateral both describe unilateral procedures meaning just one ear.
Coding for removal of impacted cerumen 69210 journal of. This means the providers documentation for the em service is significantly and separately identifiable. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Removal of impacted cerumen current procedural terminology cpt 69210 he billing procedure for ear lavage cpt 69210 with blue cross and blue shield of kansas bcbsks has changed since the last notification in the blue shield report s1400. Cerumen removal means the non routine removal of cerumen within the cartilaginous ear canal necessary for access in performance of audiological procedures under the supervision of a physician and surgeon.
However, general practitioners, emergency department staff, nurses, audiologists, audiological physicians, and alternative medicine practitioners may all be confronted with the scenario of exce. Bleeding is usually slight and resolves on its own. Is the physician allowed to bill for the removal of impacted cerumen if it was done by the ma or by a registered nurse. The process is to first soften the wax thats impacted. Be sure you document the specific type of instrumentation used e. Brenda edwards, cpc, cpma, cpci, cemc aapcca board of directors.
Someone told me to bill an em code like 99212 or 99202, instead of 69210 when removing impacted cerumen with instrumentation. One of the important criteria continue reading pesky cerumen impaction codes. Documentation should indicate the site of blockage and medical necessity of removal such as hearing loss, discomfort, blockage that prevents examination. All general practices should have a nurse trained in delivering ear irrigation with water. Bank on this definitive coders guide to cerumen removal. Sep 01, 2007 69210 always involves the diagnosis of impacted cerumen, so it seems reasonable to always attach the code for impacted cerumen 380. Huge ear polyp discovered after ear wax removal mr. Jul 22, 2019 patients presenting with earwax impaction need access to earwax removal services in primary care. Removal of cerumen wax from the ear forms a significant part of the workload of an otolaryngologist and is, therefore, an essential skill to master. If patients continue to use it after ear wax removal, their ears quickly days return to health.
As an alternative, if you have an individualized coding or billing question, and you are a member of the american college of surgeons acs, you can access. To ensure proper reporting of 69210, documentation in the medical record should ideally include. Listen up for these tips for reporting cerumen disimpaction. However, variability in the assessment was probably marginal because prior to the study all the participants received specific instructions and. For clinical feedback on your inquiry, please consider posting on entconnect. Auditing for cerumen removal codes 69209, 69210 findacode. If earwax is impacted it may be removed by one of two general methods. This webpage is used to structure an article produced by cms or noridian. Removal of impacted cerumen 69209 ama cpt assistant.
If the earwax isnt impacted, removal is included in the documented evaluation and management em service reported and. And most accounts receivable software can be set up to automatically post eft payments to your patients accounts. Cerumen removal which scenarios are reported with 69210. Asa,llc disclaimer this presentation is designed to provide accurate and authoritative information in regard to the subject matter covered. Cerumen removal with office visit otolaryngology coding.
The purpose of this article is to clarify claim submission instructions when. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. As an alternative, if you have an individualized coding or billing question, and you are a member of the american college of surgeons acs, you can access the acs coding hotline at 8002277911. Method determines coding for impacted cerumen removal. A new cerumen impaction code was revealed at the annual cpt ama. My doc keeps coding the encounter sheets charging high level visit code with 69210 for cerumen impaction. For removal by lavage, the correct code is 69209 removal impacted cerumen using irrigationlavage, unilateral. The academy is proud to release our aaohns coding corner as a benefit for members. I have been informed of my condition and consent is hereby. That said, it is never appropriate to report 69990 with 69210 because 69990 is meant for microsurgical techniquesmicrodissection. Nov 29, 2017 the process is to first soften the wax thats impacted.
Oaktree products the leading provider of clinical supplies to the hearing care industry. Rejections for claims for removing impacted cerumen. If you are attempting to code an em code in addition to code 69210. The correct way to remove impacted earwax that worked for me.
You might report additional diagnoses, however, to support an associated em code or to document associated signs and symptoms. May 09, 2018 removal of cerumen wax from the ear forms a significant part of the workload of an otolaryngologist and is, therefore, an essential skill to master. January 2020 update of the ambulatory surgical center cms. The rules that apply to the two cerumen removal codes now available for use mean that auditors will need to scrutinize the documentation. This is supplied in a dropper bottle that can be used to place the required amount of fluid in the canal usually 5 to 10 drops. Here is an illustration of how cerumen is often removed at the ent surgeons office. July 14th, 2017 by rebecca bailey modifiers help tell the story of what the provider did or didnt do, but too often we get confused when to use the right ones. As an otolaryngology coder, youre probably all too familiar with the underlying coding processes behind a cerumen removal office visit. Oct 17, 2016 method determines coding for impacted cerumen removal. Billing and reimbursement for cpt code 69210 or hcpcs code g0268 is limited to clinical circumstances where documentation supports these to be reasonable and necessary services requiring a physicians skill.
Medical clinical policy bulletin updates health care. There has been a recent surge in calls to our provider contact center regarding cpt code 69210 removal of impacted ear wax. The new code, 69209 removal impacted cerumen using irrigationlavage unilateral has no work value rvus. Cerumen removal coding depends on impaction, method aapc. Coding corner american academy of otolaryngologyhead and. Removal of impacted cerumen requiring instrumentation. Paramount applies coding edits to all medical claims through coding logic software to. As a result, the procedure can be performed by a nurse as presented in the clinical example from the ama editorial panel. Of course, the physician documentation should clearly demonstrate the presence of impacted cerumen, as defined above. The only time youll receive separate payment for both an em visit in addition to the removal of impacted cerumen is if the em service is for something totally unrelated to the impacted cerumen. As a result of his examination of the affected ear, the doctor asked the ma to remove excessive ear wax 69210, removal impacted cerumen separate procedure, one or both ears. Precautions check with your state to ensure cerumen removal is within your scope of practice inform your clinic that you plan on performing cerumen removal follow the universal precautions contained in the cdc for bloodborne pathogens gloves, masks as needed ensure your liability insurance covers cerumen removal obtain informed consent and release of liability.
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