ED Coding and Reimbursement Alert

Question: The ED physician saw an 18-year-old female patient with complaints of ear pressure and reduced hearing on both sides, and feared she had burst her eardrums. Upon examination, the ED physician noted that the patient did not have any other signs and symptoms and had no signs of infection in the ears or tympanic membrane perforation, but documented the presence of cerumen, which he cleared by irrigation. Which code applies?

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Answer: In this case scenario, you will have to report only the appropriate emergency department E/M code for the visit.

If your doctor removed impacted cerumen through lavage or irrigation, you could report it with 69209 (Removal impacted cerumen using irrigation/lavage, unilateral). In order to report 69209, however, it is essential that the cerumen that the doctor removed from the ear is impacted.

The description of the code will guide the provider on what condition the patient has and what needs to be performed and thus documented in order to bill one of these codes. If cerumen is NOT impacted, the instructional notes in CPT^® say to use an E/M code. The inclusion of the term "impacted cerumen" in the code descriptor to 69209 and a parenthetical note after the code reinforces this point. So you may wish to educate your providers to be sure to document the cerumen was impacted, if in fact it was upon examination.

So, while you cannot report 69209 for the removal of cerumen that is not impacted, if your clinician performs this procedure, you will just have to include the work in the E/M service code that you are reporting for the visit.