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- Thread starter andrews24
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mitchellde
True Blue
First may I inquire as to who is performing the procedure in your office.
nc_coder
Expert
This is not my original post, but I will answer the question for our office. The CMAs are doing the lavage in our office. I am fairly new to the Family Practice coding so I like to see what everyone else is asking and learn from it.
mitchellde
True Blue
69210 must be performed by a physician and is more that a lavage it must involve the use of a scoop or currette and there must be a procedure note by the provider.
Here is a quote from the CMS LCD:
Impacted cerumen removal is the extraction of hardened or accumulated cerumen from the external auditory canal by mechanical means, such as irrigation or debridement.
Generally, the simple/routine removal of cerumen (e.g., softening drops, use of cotton swabs and/or cerumen spoons) is considered a part of the office visit and therefore cannot be separately reimbursed on the same day as an Evaluation and Management (E&M) service.
Indications
Payment may be made for the removal of impacted cerumen when ALL of the following are met:
the service is the sole reason for the patient encounter,
the service is personally performed by a physician or non-physician practitioner, (i.e., nurse practitioner, physician assistant, clinical nurse specialist),
the service is provided to a patient who is symptomatic, and
the documentation illustrates significant time and effort spent in performing the service.
In the above situation the E&M service is included in the fee for the removal of impacted cerumen, therefore, an E&M service is not separately payable.
Payment consideration may be made for both the procedure and the E&M service if ALL of the following conditions exist:The nature of the E&M visit is for something other than removal of impacted cerumen.
During an unrelated patient encounter (visit), a specific complaint or condition related to the ear(s) is either discovered by the physician or brought to the attention of the physician/non-physician practitioner by the patient.
Otoscopic examination of the tympanic membrane is not possible due to a cerumen obstruction in the canal.
The removal of impacted cerumen requires the expertise of a physician or non-physician practitioner and is personally performed by the physician or non-physician practitioner.
The procedure requires a significant amount of the physician's/non-physician practitioner's effort and time.
Documentation is present in the patient record to identify the above criteria have been met.
Limitations
Removal of impacted cerumen performed by someone other than the physician or non-physician provider is not billable.
Simple cerumen removal performed by the physician or office personnel (e.g., nurses, office technicians) is not medically necessary and therefore, not separately payable.
An E&M service and the removal of impacted cerumen are not separately payable when the sole reason for the patient encounter is for the removal of impacted cerumen.
The patient is asymptomatic (e.g., denies pain, hearing loss, vertigo, etc.).
Visualization aids, such as, but not necessarily limited to, binocular microscopy, are considered to be included in the reimbursement for 69210 and G0268 and should not be billed separately.
Most patients do not require medically necessary disimpaction of cerumen by a physician. Patients who require this service more often than 3-4 times per year would be unusual.
NOTE: If this service is performed in the skilled nursing facility and/or nursing facility, please see LCD #L27485, LCD #L27496, and NCD 70.3, for additional guidance.