tlwhlw
Networker
Does anyone have info for this new CPT code for 2016? I have one reference to Wisconsin Medical Society "Practice Vitals". Not sure how legit this website is, so would like to confirm any other info that's out there. Here's the article that was dated 1/05/2016:
CPT® code for ear wax removal introduced in 2016
Current Procedural Terminology (CPT®) for 2016 introduced a new code—69209 Removal impacted cerumen using irrigation/lavage, unilateral—for reporting the removal of impacted ear wax. The intent is for clinical staff to provide this service under the supervision of a physician or other qualified health care professional, and the reimbursement reflects this as there is only practice expense relative value and no physician work value assigned. National Government Services will reimburse physicians for this service at $12.18 (par, NF). This is the first time Medicare will reimburse for cerumen removal without the use of instrumentation. The current CPT® code 69210 is for direct method of ear wax removal utilizing curettes, hooks, forceps and/or suction.
The identification of a cerumen impaction is key to the medical necessity of the service. Establishing cerumen impaction is based on several clinical considerations including visual (cerumen impairs exam), qualitative (hard, dry cerumen causing pain, itching or hearing loss), inflammatory (associated with foul odor, infection or dermatitis), and/or quantitative (obstructive copious cerumen that requires physician intervention). The decision to perform the removal of impacted cerumen by irrigation or lavage should be determined by the physician or other qualified health care professional and carried out and documented by the clinical staff.
If the physician or other qualified health care professional determines there is ear wax, but it is not impacted, the removal (if any) is not separately reportable and is considered bundled into the evaluation and management service for that day.
ICD-10-CM codes clearly identify laterality and impaction status, which will support the medical necessity of the service. See codes H61.20-H61.23.
My providers have not been billing for 69210 as we do not have the tools required to use this CPT code. Curious to see if what we do qualifies for 69209.....thank you!
CPT® code for ear wax removal introduced in 2016
Current Procedural Terminology (CPT®) for 2016 introduced a new code—69209 Removal impacted cerumen using irrigation/lavage, unilateral—for reporting the removal of impacted ear wax. The intent is for clinical staff to provide this service under the supervision of a physician or other qualified health care professional, and the reimbursement reflects this as there is only practice expense relative value and no physician work value assigned. National Government Services will reimburse physicians for this service at $12.18 (par, NF). This is the first time Medicare will reimburse for cerumen removal without the use of instrumentation. The current CPT® code 69210 is for direct method of ear wax removal utilizing curettes, hooks, forceps and/or suction.
The identification of a cerumen impaction is key to the medical necessity of the service. Establishing cerumen impaction is based on several clinical considerations including visual (cerumen impairs exam), qualitative (hard, dry cerumen causing pain, itching or hearing loss), inflammatory (associated with foul odor, infection or dermatitis), and/or quantitative (obstructive copious cerumen that requires physician intervention). The decision to perform the removal of impacted cerumen by irrigation or lavage should be determined by the physician or other qualified health care professional and carried out and documented by the clinical staff.
If the physician or other qualified health care professional determines there is ear wax, but it is not impacted, the removal (if any) is not separately reportable and is considered bundled into the evaluation and management service for that day.
ICD-10-CM codes clearly identify laterality and impaction status, which will support the medical necessity of the service. See codes H61.20-H61.23.
My providers have not been billing for 69210 as we do not have the tools required to use this CPT code. Curious to see if what we do qualifies for 69209.....thank you!