Primary Care Coding Alert

Question: Our physician removed cerumen using a Waterpik. He says that this is an -instrument- and therefore we can report 69210 for this service. Is this accurate?


Florida Subscriber


Answer: No. An ear wash does not meet the requirements to report 69210 (Removal impacted cerumen [separate procedure], one or both ears). According to the July 2005 CPT Assistant, -Removing wax that is not impacted does not warrant the reporting of CPT code 69210.-

The AMA states that payment for nonimpacted wax removal is included in the E/M reimbursement. But CPT Assistant states, -If, however, the wax is truly impacted, then its removal should be reported with 69210 if performed by a physician using at minimum an otoscope and instruments such as wax curettes,- or in some cases, -with an operating microscope and suction plus specific ear instruments (e.g., cup forceps, right angles). Accompanying documentation should indicate the time, effort, and equipment required to provide the service.-

Some payers are even stricter than this when writing up their 69210 guidelines. For example, First Coast Service Options, the Medicare payer in Florida, published a bulletin in February 2005 that states that the only reimbursable method of impacted cerumen removal -- is performed by the physician under binocular magnification and generally entails grasping the cerumen plug with forceps, application of suction, and/or extraction with a right-angle hook. In cases of severely impacted ears, injections of local anesthesia may be required.-

Several Medicare carriers, such as Empire Medicare (a Part B payer in New York and New Jersey), will only reimburse 69210 three to four times per year. Because some patients are seeing other physicians (such as an otolaryngologist) for their cerumen removal services, you can't always be sure that the patient hasn't already fulfilled her 69210 frequency limits within any given 90-day period.

Best practice: Unless you-re sure that no other physician is billing out 69210 to Medicare for that patient, you should use an ABN every time you perform cerumen removal on that patient.