# 69210 removal of cerumen



## coders_rock! (Jun 30, 2011)

Can you bill 99385, 69210, and 93000 together?


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## Pam Brooks (Jun 30, 2011)

It's ok to bill the 93000 with the Pe, just place a -25 on the 99385, and make sure you have the physician's  interpretation/report to bill the global EKG (not just the strip).

Billing the cerumen removal depends on the situation.  If the patient presented with acute/chronic cerumen impaction, and the provider used a cerumen spoon or other instrument to remove it (lavage doesn't count), then you can bill it as long as it wasn't removed only so that the provider could view the tympanic membranes during the exam.  The provider should document impaction, and the fact that it was bothersome, not just that it needed to be removed to complete the physical.  This shows medical necessity.

If you can also bill the 69210, place the -59 on the 93000.


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## coders_rock! (Jun 30, 2011)

Thank you so much pam.


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## nc_coder (Jul 7, 2011)

*Question for you Pam*



Pam Brooks said:


> It's ok to bill the 93000 with the Pe, just place a -25 on the 99385, and make sure you have the physician's  interpretation/report to bill the global EKG (not just the strip).
> 
> Billing the cerumen removal depends on the situation.  If the patient presented with acute/chronic cerumen impaction, and the provider used a cerumen spoon or other instrument to remove it (lavage doesn't count), then you can bill it as long as it wasn't removed only so that the provider could view the tympanic membranes during the exam.  The provider should document impaction, and the fact that it was bothersome, not just that it needed to be removed to complete the physical.  This shows medical necessity.
> 
> If you can also bill the 69210, place the -59 on the 93000.



Can you tell me where I can find it written that the 69210has to be done with the spoon or other instrument and not just a lavage.  My doctors want to charge 69210 on everyone that gets a lavage.  Is there another code that should be used when the nurses do the lavage?


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## Mojo (Jul 7, 2011)

Hi Jennifer:

CPT Assistant July 2005:13-16
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...

The AAO-HNS defines impacted cerumen as:
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.


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## nc_coder (Jul 8, 2011)

thanks Mojo.  Very helpful!


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