# 69210 vs 69200



## kmacrae (Jul 24, 2008)

I work for an urgent care and we have patients coming in regularly for ear wax removal. Should we be billing all insurance companies a 69210 or 69200. Most insurance companies won't cover a 69210, but will cover a 69200. Is ear wax considered a foreign body?


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## dmaec (Jul 24, 2008)

I'm guessing neither - I'm betting you should be charging and E/M level only (probably a very low level E/M) - Who actually performs the ear was removal?  are they really removing impacted ear wax or just flushing the ear wax build up?
69210-"under direct visualization, the physician removes impacted cerumen (ear wax) using suction, a cerumen spoon, or delicate forceps.  If no infection is present the ear canal may be irrigated.  Some sort of "tool" is used.

Cerumen removal is "MORE" than simple ear irrigation (washing).  The ear was must be "impacted" not just built up and washed out.

69200 -"under direct visualization, the physician or technician removes a foreign body from the external auditory canal using delicate forceps, a cerumen spoon or suction.  In the case of a live insect, oil is dropped into the ear to immobilze it before it is removed. No anesthetic or local anesthetic is used.  again, some sort of tool is used. Ear wax is not a foreign body.

however - if your facility is really removing impacted cerumen - using the correct tools, procedure done by the physician (not nurse or other) and documentation fully supports the procedure - then 69210 would be correct.  And you're correct, the insurance company doesn't like to pay - but - if done correctly, appeal it.


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## mbort (Jul 24, 2008)

This may help--from the CPT assistant:

Surgery: Auditory System

In collaboration with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), we present the following discussion which provides some typical coding scenarios with regard to the appropriate use and application of CPT codes related to ear wax removal:

1.         The patient presents to the office for the removal of “ear wax” by the nurse via irrigation or lavage.

2.         The patient presents to the office for the removal of “ear wax” by the primary care physician via irrigation or lavage.

3.         The patient presents to the office for “ear wax” removal as the presenting complaint. This is described as impacted cerumen because it completely covers the eardrum and the patient has hearing loss. The impacted cerumen is removed by the primary care physician or otolaryngologist with magnification provided by an otoscope or operating microscope and instruments such as wax curettes, forceps, and suction.

Question:Are these procedures appropriately reported with CPT code 69210, Removal impacted cerumen (separate procedure), one or both ears?

AMA Comment: A major element in determining whether code 69210 should be reported is understanding the definition of impacted cerumen. By definition of the AAO-HNS, “If any one or more of the following are pre-sent, cerumen should be considered ‘impacted' clinically:

Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.
Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc.
Inflammatory considerations: Associated with foul odor, infection, or dermatitis.
Quantitative considerations: Obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations requiring physician skills.”
Other issues may also require consideration. Removing wax that is not impacted does not warrant the reporting of CPT code 69210. Rather, that work would appropriately be captured by an evaluation and management (E/M) code regardless of how it is removed. If, however, the wax is truly impacted, then its removal should be reported with 69210 if performed by a physician using at minimum an otoscope and instruments such as wax curettes or, in the case of many otolaryngologists, with an operating microscope and suction plus specific ear instruments (eg, cup forceps, right angles). Accompanying documentation should indicate the time, effort, and equipment required to provide the service. Add-on code 69990, Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure), should not be reported if the operating microscope is used for cerumen removal. In this later instance, however, code 92504, Binocular microscopy (separate diagnostic procedure), may be reported.

Therefore, based on this information, scenarios 1 and 2 would not be reported with code 69210. These scenarios would be captured by the appropriate E/M code. Scenario 3, however, should be reported with code 69210 because both criteria were met; the patient had cerumen impaction and the removal required physician work using at least an otoscope and instrumentation rather than simple lavage.


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## Candice_Fenildo (Jul 25, 2008)

MBORT !!!

Well Put! and Donna you as well. I Code ENT. and you both are Right.


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## dmaec (Jul 25, 2008)

Thanks Candyr!  and yes, I printed the info from mbort!  I could not for the life of me find that info in CPT assistant.  I had it at my other job, no idea why I can't find it here, (I know I took my info)! LOL.. but - I'm so glad you printed that mbort!  THANKS!


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