# Cerumen Removal/CMS Regs



## dballard2004 (Aug 28, 2009)

Can anyone point me in the direction of CMS guideance on cerumen removal? I have CPT Assistant from July 2005 that addresses this, but I am needing Medicare regs as well, please. I have gone to the CMS website with no luck. Thanks.


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## RebeccaWoodward* (Aug 28, 2009)

My carrier has a policy on this......

*Modifier 25 and Ear Lavage *

Q: Can an established patient visit and ear lavage be paid the same dos? 

A: *Ear lavage to remove ear wax would be considered part of an evaluation and management visit*. Ear lavage may be done by either the physician or his/her staff. If a patient had impacted cerumen removed by the physician (e.g. *via curettes*) then CPT code 69210 could be billed. (Removing wax that is not impacted does not warrant the reporting of CPT code 69210) 

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. For example, a visit on the same day could be properly billed in addition to irrigating the ears if, for example, a neurological assessment was medically necessary — i.e. done because the patient exhibited symptoms beyond those attributable to impacted cerumen: but, billing for a visit would not be appropriate if the physician only identified the need to remove the impacted cerumen. (See CMS Publication 100-4, the Claims Processing Manual, Chapter 12, section 40.1, subsection C via the attached link: 
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf


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## dballard2004 (Aug 28, 2009)

Thanks this is actually what I was looking for.


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## RebeccaWoodward* (Aug 28, 2009)

Dawson,

For some reason, I didn't notice your location before.  Looks like Cigna Government Services is also your MAC.  See Question #2...

http://www.cignagovernmentservices.com/partb/help/faqs/mr/01_06.html


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