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Wiki cerumen removal - appropriate tools
- Thread starter baran
- Start date
mitchellde
True Blue
since the impacted cerumen removal was for the physician convenience, it is considered to be part of the exam and is not separately chargeable.
mcnaryk
Guru
From personal experience, I know I have been billed for both an E/M and cerumen removal for an office visit and my insurance processed it. I don't consider the removal of the cerumen to be for convience-the doctor could not accurately diagnose the patient since the ear canal was obstructed. Once the wax was removed and the ear canal visable, then the diagnosis of otitis media was made. I think you can bill for both.
mitchellde
True Blue
Exactly, the physician could not diagnose the problem until the ear wax was removed, that is why it was for the convenience of the physician, the patient's problem was not due to or caused by the cerumen, it was an inconvenience to the physician. I know this was covered in a CPT assistant some time ago, and I remember seeing it in a Decision Health article. You can bill for both yes but the question is always SHOULD you bill for both, and in this instance you should not.
KERRIEA
Networker
We bill separately for impacted cerumen removal in the above instance.
CMS has a list of conditions that allow you to bill an E/M code and the 69210 if the following requirements are met.
The nature of the e/m is for anything other than cerumen removal (in your example, ear pain)
Otoscopic exam of the tympanic membrane is not possible due to impaction
Removal of the imapction requires the expertise of the provider and is personally performed by the provider
Go to this link for further info on this subject
http://www.entnet.org/Practice/Coding-for-Cerumen-Removal.cfm
Hope this helps.
CMS has a list of conditions that allow you to bill an E/M code and the 69210 if the following requirements are met.
The nature of the e/m is for anything other than cerumen removal (in your example, ear pain)
Otoscopic exam of the tympanic membrane is not possible due to impaction
Removal of the imapction requires the expertise of the provider and is personally performed by the provider
Go to this link for further info on this subject
http://www.entnet.org/Practice/Coding-for-Cerumen-Removal.cfm
Hope this helps.
Amanda__
New
we bill separtely for both the visit and removal of ear wax without any denials.
Pam Warren
True Blue
Because the impacted cerumen has visual considerations (i.e. Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition), it would appear you can bill for the cerumen removal. However, this instruction does say that the presenting problem must be related to the cerumen removal--not a preventive exam, and it does say that the cerumen must be truly impacted. In those cases you could not bill additionally. The -25 would bypass the edits, which is why physicians are getting paid, but it might not always be appropriate. As a matter of internal policy, we will not bill out cerumen removal additionally when done at the preventive exam. We consider it inherent to the ENT exam, in order that it be completed successfully.
From CPT assistant:
In collaboration with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), we present the following discussion which provides some typical coding scenarios with regard to the appropriate use and application of CPT codes related to ear wax removal:
1. The patient presents to the office for the removal of "ear wax" by the nurse via irrigation or lavage.
2. The patient presents to the office for the removal of "ear wax" by the primary care physician via irrigation or lavage.
3. The patient presents to the office for "ear wax" removal as the presenting complaint. This is described as impacted cerumen because it completely covers the eardrum and the patient has hearing loss. The impacted cerumen is removed by the primary care physician or otolaryngologist with magnification provided by an otoscope or operating microscope and instruments such as wax curettes, forceps, and suction.
Question:
Are these procedures appropriately reported with CPT code 69210, Removal impacted cerumen (separate procedure), one or both ears?
AMA Comment:
A major element in determining whether code 69210 should be reported is understanding the definition of impacted cerumen. By definition of the AAO-HNS,
"If any one or more of the following are present, cerumen should be considered 'impacted' clinically:
Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.
Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc.
Inflammatory considerations: Associated with foul odor, infection, or dermatitis.
Quantitative considerations: Obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations requiring physician skills."
Other issues may also require consideration. Removing wax that is not impacted does not warrant the reporting of CPT code 69210. Rather, that work would appropriately be captured by an evaluation and management (E/M) code regardless of how it is removed. 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 the case of many otolaryngologists, with an operating microscope and suction plus specific ear instruments (eg, cup forceps, right angles). Accompanying documentation should indicate the time, effort, and equipment required to provide the service. Add-on code 69990, Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure), should not be reported if the operating microscope is used for cerumen removal. In this later instance, however, code 92504, Binocular microscopy (separate diagnostic procedure), may be reported.
Therefore, based on this information, scenarios 1 and 2 would not be reported with code 69210. These scenarios would be captured by the appropriate E/M code. Scenario 3, however, should be reported with code 69210 because both criteria were met; the patient had cerumen impaction and the removal required physician work using at least an otoscope and instrumentation rather than simple lavage.
CPT Assistant © Copyright 1990-2012, American Medical Association. All rights reserved.
From CPT assistant:
In collaboration with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), we present the following discussion which provides some typical coding scenarios with regard to the appropriate use and application of CPT codes related to ear wax removal:
1. The patient presents to the office for the removal of "ear wax" by the nurse via irrigation or lavage.
2. The patient presents to the office for the removal of "ear wax" by the primary care physician via irrigation or lavage.
3. The patient presents to the office for "ear wax" removal as the presenting complaint. This is described as impacted cerumen because it completely covers the eardrum and the patient has hearing loss. The impacted cerumen is removed by the primary care physician or otolaryngologist with magnification provided by an otoscope or operating microscope and instruments such as wax curettes, forceps, and suction.
Question:
Are these procedures appropriately reported with CPT code 69210, Removal impacted cerumen (separate procedure), one or both ears?
AMA Comment:
A major element in determining whether code 69210 should be reported is understanding the definition of impacted cerumen. By definition of the AAO-HNS,
"If any one or more of the following are present, cerumen should be considered 'impacted' clinically:
Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.
Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc.
Inflammatory considerations: Associated with foul odor, infection, or dermatitis.
Quantitative considerations: Obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations requiring physician skills."
Other issues may also require consideration. Removing wax that is not impacted does not warrant the reporting of CPT code 69210. Rather, that work would appropriately be captured by an evaluation and management (E/M) code regardless of how it is removed. 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 the case of many otolaryngologists, with an operating microscope and suction plus specific ear instruments (eg, cup forceps, right angles). Accompanying documentation should indicate the time, effort, and equipment required to provide the service. Add-on code 69990, Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure), should not be reported if the operating microscope is used for cerumen removal. In this later instance, however, code 92504, Binocular microscopy (separate diagnostic procedure), may be reported.
Therefore, based on this information, scenarios 1 and 2 would not be reported with code 69210. These scenarios would be captured by the appropriate E/M code. Scenario 3, however, should be reported with code 69210 because both criteria were met; the patient had cerumen impaction and the removal required physician work using at least an otoscope and instrumentation rather than simple lavage.
CPT Assistant © Copyright 1990-2012, American Medical Association. All rights reserved.