cerumen removal help!!

I know this has come up before. I can't find in "writing" where is states only a physician can remove cerumen. My CPT® book just states "removal impacted cerumen 1 or both ears". I thought I saw once where it stated a nurse/MA could not remove. Also if it is only done by "water lavage" that is not billable??? Sometimes a patient comes in for a nurse visit for a ear lavage. If they are not suppose to bill for it how should a nurse visit for this be coded? Thank you
ps If anyone knows where I could find this in writing. Thanks

re: cerumen removal help!!

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.
CPT® Assistant 2005 confirms this statement.

re: cerumen removal help!!

This is what I have from the American Academy of OtoLaryngology-Head and Neck Surgery:

CMS requires that physicians meet the following criteria for reimbursement of the removal of impacted cerumen:
1.The procedure is the sole reason for the patient encounter;
2. A physician or non-physician (nurse practitioner, physician assistants, or clinical nurse specialist) carries out the treatment.
3. The patient in question is symptomatic; and
4. The supporting documentation shows significant time and effort spent performing the service.
Furthermore, for CMS reimbursement of an E/M visit and cerumen removal, the following criteria must be met:
1. The initial reason for the patient’s visit was separate from the cerumen removal.
2. Otoscopic examination of the tympanic membrane is not possible due to the impaction;
3. Removal of the impacted cerumen requires the expertise of the physician or non-physician practitioner and is personally performed by him or her; and
4. The procedure requires a significant amount of time and effort, and all of the above criteria are clearly documented in the patient’s medical record.

re: cerumen removal help!!

Well you got a lot help with this one for sure! LOL

re: cerumen removal help!!

Thank you very much!!