ED Coding and Reimbursement Alert

Question: Is irrigation of the ear canal included in the E/M or a separately billable procedure?

Louisiana Subscriber

Answer: If only irrigation is performed, then it would be included in the E/M service. Use of code 69210 (Removal impacted cerumen [separate procedure], 1 or both ears), requires that the cerumen be impacted and removed using an otoscope and instruments such as wax curettes or suction.

In the July 2005 CPT® Assistant, the AAO-HNS approved definition is offered stating that if any one or more of the following are present, cerumen should be considered to be impacted:

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.

Removing wax that is not impacted would appropriately be captured by an evaluation and management (E/M) code regardless of how it is removed.