# Modifying 25 Cerumen Impaction.



## MCotton83 (Mar 10, 2009)

Our office is trying to find out the correct way to code an Ear Lavage in the office.  My thoughts are to 25 modify the E/M because the Ear Lavage is a separate procedure, is this incorrect?


Please help
Thank You
Melissa-


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## RebeccaWoodward* (Mar 10, 2009)

Typically, an ear lavage is inclusive to the office visit.  When my phyisicians have questions about this...I always print them a copy of the AMA guidelines (already on another thread from this site)

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


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## MCotton83 (Mar 10, 2009)

I understand, i may not have explained it as well as i am confused. 

if a pt comes in to our Urgent Care for ear pain, then the 69210 was done w/ an RX given would we add the 25 mod to the E/M?


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## RebeccaWoodward* (Mar 10, 2009)

Gotcha...In that case, Yes.  Modifier 25 goes on the E/M.


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## Coding82 (Mar 10, 2009)

what if a RX was not given?


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## RebeccaWoodward* (Mar 10, 2009)

Ok...let me back up.

If the physician removes impacted cerumen with instrumentation, you can report 69210 for the service. If the physician/NPP removes the cerumen with lavages or other solutions, personally, I wouldn't report 69210.

“Impacted” definition: For coding purposes: "impacted” cerumen is “packed tightly in the outer ear, so much so that the external ear canal is blocked. The ear wax is hard and possibly crusted"

As far as billing an E&M visit in addition to removal of impacted cerumen, visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a *significant, separately identifiable service is also performed*.  With that being said, I personally don't feel that a RX is the winning factor that determines billing 69210 and an E/M.  If there is a *significant, separately identifiable service* performed in addition to 69210 and documentation supports both, you have a billable claim.


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