ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of pain, with wax buildup in her left ear. One of our nonphysician practitioners (NPPs) removed the wax using lavage, some solvents, and ultimately curettage. Can we report 69210 for this encounter? Or is 69210 for physicians only?

Indiana Subscriber

Answer: There are two questions here, so we'll address them one at a time:

Can we report 69210? You can report 69210 (Removal impacted cerumen [separate procedure], one or both ears) for this visit based on the scenario above. Keep in mind, however, for Medicare you would report this service under the NPP's national provider identifier (NPI) number. There is no such thing as a "shared procedure" according to Medicare transmittal 1776, which governs NPP billing for E/M services only.

Payers may vary slightly as to what they consider impacted cerumen (380.4, Impacted cerumen), but the condition is typically marked by earwax blocking a portion of the external auditory canal or the tympanic membrane. This wax is often hard, dry, and painful.

During a 69210 encounter, the provider typically removes the cerumen using one of these instruments: suction, probes, forceps, right-angle hooks, or wax curettes.

Additionally, you will likely choose the appropriate level E/M code for the NPP's service, such as 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision making of low complexity) with 388.70 (Otalgia) appended to 99282 to prove medical necessity.

Is 69210 for physicians only? It depends on the carrier. As long as it is within the NPP's scope of practice, she has the proper state licensure, and she uses instrumentation to remove impacted cerumen, most insurers will pay for 69210 that an NPP performs.

Best practice: If you are unsure about a payer, check you contract or contact a rep, then file the claim.