Primary Care Coding Alert

Take this test to see if your cerumen removal guidelines require updating

The AMA silences consultants- various interpretations on 69210 with clear-cut directives on the code's requirement.

One article states a nurse can perform 69210, another stipulates a physician has to provide the service, and yet another advises reserving the code for cases involving instrumentation. What and whom should you believe? CPT Assistant comes to the rescue. Check Your 69210 Coding Aptitude With 3 Scenarios Educate your staff on how to code ear-wax-related encounters--and see if your cerumen coding policy needs updating--with this quick quiz: Question: Which of the following scenarios should you report with 69210 (Removal impacted cerumen [separate procedure], one or both ears)?

1. A nurse removes earwax via irrigation or lavage.

2. A primary-care physician removes earwax via irrigation or lavage.

3. A patient with earwax as the chief complaint presents to the office. Documentation describes the wax as impacted cerumen because it completely covers the eardrum and causes the patient hearing loss. A primary-care physician removes the impacted cerumen with magnification provided by an otoscope and instruments such as wax curettes, forceps and suction. Answer: Only scenario 3 qualifies as 69210, according to CPT Assistant July 2005. You should report 69210 for impacted cerumen removal only.  Alternative: If a nurse or family physician removes earwax, as in scenarios 1 and 2, you should instead include the work in the appropriate-level E/M code. -CPT 69210's clarification will have a big impact on physicians and coders,- says Linda Weiss, billing and coding specialist at Seattle Primary Physicians. Hopefully, the AMA will eventually create an -ear irrigation- code to identify the procedure's work component as separate from the E/M service, she adds.

To help staff determine whether a case involves impacted cerumen (380.4, Impacted cerumen), use the following definition, offered by the American Academy of Otolaryngology-Head and Neck Surgery. You should consider cerumen impacted if any one or more of the following conditions are present:

- Visual: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.

- Qualitative: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching and/or hearing loss.

- Inflammatory: Associated with foul odor, infection, or dermatitis.

- Quantitative: Obstructive, copious cerumen that require a physician's skill to remove with magnification and multiple instrumentations. Limit 69210 to Cases Involving FP Using Instrument To assign 69210, a physician must remove impacted cerumen using instrumentation. The FP must use, at minimum, an otoscope and instruments, such as wax curettes. The AMA's clarification mirrors many Medicare carriers- guidelines.

-Medicare carriers have always had pretty strict interpretations regarding the payment of 69210,- says Sherry Wilkerson, RHIT, CCS, CCS-P, coding and compliance manager at Catholic Healthcare Audit Network in Clayton, Mo. [...]