Otolaryngology Coding Alert

Question: I have been looking at the earwax removal code 69209 (Removal impacted cerumen using irrigation/lavage, unilateral), and I noticed that the code includes irrigation and lavage. Since lavage used to be bundled into evaluation and management (E/M) codes, can we ever report 69209 along with a separate E/M code?

California Subscriber

Answer: It depends on the insurer’s policy, as well as the thoroughness of your documentation.

The provider has to demonstrate a strong significant and separately identifiable E/M service with removal of impacted cerumen. Many third-party payers will not pay for an E/M, even with strong support for the 25 modifier, if the only diagnosis is impacted cerumen for both services.

An example where most payers would reimburse both cerumen removal and an E/M would be if the patient presents with vomiting, throat pain, and a fever. The physician examines the patient, and during the examination he notes cerumen that is impacted in the ear. After the E/M, the nurse performs cerumen removal with irrigation.

You should be able to report the E/M with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended, because the E/M would not be considered related to the cerumen removal. Then you could report 69209 for the cerumen removal. Check the documentation to confirm whether the E/M is complete and significant enough to warrant reporting.

Remember: The 69209 code does not have physician work relative value units (RVUs). This is because 69209 is a nurse or medical assistant service where the provider irrigates and lavages in order to remove the impacted cerumen.