69210 Cerumen removal

The CPT® Assistant clarified the rules for using code 69210 in the July 2005 newsletter.  The key points for using this code:

• Ear lavage alone is insufficient: the ear wax must be removed by curette or instrumentation
• The billing provider must perform the service, not the nurse or medical assistant
• The cerumen must  be impacted, which means it must have one of these four characteristics:
• •    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.

Some physicians may use an operating microscope or suction, but the operating microscope  69990 is not separately reimbursed.  However, the CPT® Assistant states that 92504, , Binocular microscopy (separate diagnostic procedure), may be reported.

If the ear wax is not impacted, meeting the criteria listed above, it is not separately reported.