Oncology & Hematology Coding Alert

Question: Our physician sometimes decides a patient with head and neck cancer needs earwax removed to prevent diffusion of the radiation beam. How should we report this? With 69210?

Kansas Subscriber

Answer: If the oncologist uses instruments to remove impacted cerumen, then you may consider reporting 69210 (Removal impacted cerumen requiring instrumentation, unilateral).

According to CPT^® Assistant, clinically impacted cerumen must meet one or more of the following:

• "impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition"  
• causes pain, itching, or other symptoms because the cerumen is hard, dry, and irritating 
• is associated with odor, infection, or dermatitis 
• requires magnification and "multiple instrumentations requiring physician skills" to remove.

"Accompanying documentation should indicate the time, effort, and equipment required to provide the service," CPT^® Assistant states. Instruments may include wax curettes, forceps, and suction. If the documentation doesn’t support the use of an instrument, consider code 69209 (Removal impacted cerumen using irrigation/lavage, unilateral) if the physician used irrigation/lavage. Note the code descriptor for both 69209 and 69210 indicate unilateral; for bilateral procedures, append modifier 50. For cerumen removal, but not impacted, see E/M service codes.