Question: A speaker recently advised our practice that we shouldn’t report 69210 for ear lavage to remove impacted cerumen. On the other hand, the Coders’ Desk Reference (CDR) says of 69210, "Under direct visualization, the physician removes impacted cerumen (ear wax) using suction, a cerumen spoon or delicate forceps. If no infection is present, the ear canal may be irrigated."
Does the description’s last sentence support irrigation as an appropriate means of removing impacted cerumen?
South Carolina Subscriber
Answer: Actually, the final sentence in the CDR description of 69210 (Removal impacted cerumen [separate procedure], one or both ears: APC 0340) is an add-on describing work that could occur after the physician removes the impacted cerumen using instrumentation. The provider would use the ear lavage as an additional or final cleansing step.
The AMA, in the July 2005 CPT Assistant, clearly indicates that you should report 69210 only when the service meets two criteria:
1. the patient had "cerumen impaction" including blocking visualization of the tympanic membrane
2. the removal required physician work using at least an otoscope and instrument, rather than simple lavage.
Example: The AMA illustrates the appropriate use of 69210 with the following scenario: The patient presents to the office for "ear wax" removal as the presenting complaint. Documentation describes this as impacted cerumen because it completely covers the eardrum and the patient has hearing loss. The otolaryngologist removes the impacted cerumen with magnification provided by an otoscope or operating microscope and instruments such as wax curettes, forceps and suction.
Under APC guidelines, 69210 is a minor ancillary service eligible for separate payment.
