# ear lavage



## wynonna (Dec 18, 2016)

Can anyone tell me if a provider does bilateral ear lavage, can 69210 or 69209 be coded twice since the provider is doing twice the work?  ie on both the right and left ears in the same visit
If yes, which modifier applies and how many times is 69210 coded for instrumentation?  
or 69209 for irrigation?
Thank you


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## CodingKing (Dec 18, 2016)

Bilateral would be modifier 50.


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## thomas7331 (Dec 19, 2016)

Medicare does not accept 69210 billed as a bilateral procedure, however some private payer may.  69209 may be billed bilaterally.


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## ljones88 (Dec 27, 2016)

*Ear Lavage*

If the dr is performing *lavage only* bill 69209. Do not bill 69210 when only lavage is the method of removal...

For 69210: DO NOT append modifier 50 as it is considered bilateral in nature although the description of the procedure itself states unilateral (_Removal impacted cerumen requiring instrumentation, *unilateral*_).  

I have handled coding and auditing for ENTs for the last 6 years and 69210 will not be paid if 50 modifier is appended to the code no matter how you appeal it (at least in Florida). 

For 69209: You can append modifier 50 as it is considered unilateral in nature (at least for now).  _Removal impacted cerumen using irrigation/lavage, *unilateral*_

Coding guidelines have always stated that you must have documentation of the cerumen being impacted before you could submit 69210. If the cerumen wasn’t impacted or if the physician didn’t use any type of instrumentation (forceps, suction, currettes, anything other than just lavage) during the removal, the service was included in a typical E/M code, (i.e. "Otoscopic exam of the tympanic membrane is not possible due to cerumen obstruction in the ear canal. The removal of the impacted cerumen was performed by the expertise of a physician. The procedure required a significant amount of physician effort and time.")

Cerumen Removal instrumentation is defined as the use of an otoscope and other instruments such as wax curettes, wire loops, or suction plus specific ear instruments (e.g., cup forceps, right angle hook). Accompanying documentation should indicate the equipment required to provide the service. The specification that the code requires instrumentation (vacuum evacuation & forceps removal are classified as instrumentation, but removing cerumen by lavage, cotton swab, or drops is not).

The doctor will have to demonstrate that their E/M is a significant and separately identifiable service (represented by modifier 25) in order to bill an E/M and 69209. 

I have copies of the Clinical Practice Guidelines: Cerumen Removal by the AAFP if you would like to read through it for more information on documentation requirements for 69210, attached.


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