# Help with 69210



## csamps/CPC (Mar 16, 2009)

I have been asked by my supervisor to send her some documentation in the form of e-mail from our AAPC forum in regards to procedure code 69210.  I told her it has to be performed by a physician, PA, etc.  My understanding is that a lavage can't be performed by a nurse.    I would like a link to a site or some documentation to send her, as she wants to distribute this to the doctors for their feedback.  Any help will be greatly appreciated.  Thanks.

Cindy, CPC


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## RebeccaWoodward* (Mar 16, 2009)

I always refer back to this link.  Mary's post is very informative.

https://www.aapc.com/MemberArea/forums/showthread.php?p=24392


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## Anna Weaver (Mar 16, 2009)

*69210*

Here's what CPT assistant has to say:

 	Ear wax removal 
	CPT Assistant, July 2005 Page: 14   Category: Coding Consultation
	Related Information
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 present, cerumen should be considered 'impacted' clinically:

Ÿ Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.

Ÿ Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc.

Ÿ Inflammatory considerations: Associated with foul odor, infection, or dermatitis.

Ÿ 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.




CPT Assistant © Copyright 1990–2008 American Medical Association. All Rights Reserved


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## FTessaBartels (Mar 16, 2009)

*Lavage is NOT 69210*

Cindy,
 You wrote:  My understanding is that a lavage can't be performed by a nurse.

I think you are confusing two issues. 

CPT 69210 is for the removal of impacted cerumen requiring the use of *instrumentation*. 

Lavage (which most certainly can be performed by a nurse) is not coded with 69210; lavage is part of the E/M service. 

You're certainly on the right track with trying to get this straightened out in your office. 

I hope that helps.

F Tessa Bartels, CPC, CEMC


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## EARREYGUE (Mar 18, 2009)

I found this in my AAP coding newsletter for March...

When the nurse removes impacted cerumen, should modifier 25 be appended
to the evaluation and management (E/M) service or to code 69210 (removal of
impacted cerumen)?
Current Procedural Terminology code 69210 may be reported when a patient has cerumen
impaction and the removal requires physician work using, at a minimum, an otoscope and
instruments (eg, wax curettes). Medical record documentation must support that the cerumen
was impacted and removed by the physician. The procedure note should include a
description of what equipment and method were used for the removal (eg, type of visualization
and instruments used). Removal of impacted cerumen by irrigation or lavage, whether
performed by the nurse or physician, cannot be reported with code 69210 and is considered
part of the E/M service.
Modifier 25 (significant, separately identifiable E/M service by the same physician on the
same day of a procedure or other service) should be appended to the appropriate-level E/M
code. Modifier 25 is never appended to a non-E/M service code.


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