Oncology & Hematology Coding Alert

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

Illinois Subscriber

Answer: If the oncologist uses instruments to remove impacted cerumen, then you may consider reporting 69210 (Removal impacted cerumen [separate procedure], 1 or both ears]).

Understand 'impacted': According to CPT Assistant (July 2005), 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 reporting 69210 (for example, if the patient underwent a simple lavage), then choose the appropriate E/M code instead.