69210 help

Hi, I was hoping for some clarification on CPT code 69210. When the physician removes the cerumen does this include irrigation? Or is cerumen removed by irrigation included in the E/M code?
So only after the physician has removed the cerumen by suction, spoon or forceps he/she may irrigate if no infection is present.

Thank you for your help.

69210

CMS will consider payment for both an E&M visit and the cerumen removal only when all criteria below are met:
a. The nature of the E&M visit is for anything other than the removal of cerumen;
b. During an unrelated patient encounter, the physician observes impacted cerumen or the patient lodges a specific
complaint about his/her ear during the encounter;
c. Otoscopic examination of the tympanic membrane is not possible due to the impaction;
d. Removal of the impacted cerumen requires the expertise of the physician or non-physician practitioner and is
personally performed by them; and
e. 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.

Removing wax that is not impacted does not warrant the reporting of CPT code 69210. If it is necessary to remove wax that is not impacted, this service would be captured in the reporting of an Evaluation and Management Service, regardless of how it is removed.

69210

Always a sore subject. Lavage alone does not qualify, and the removal must be done by the billing provider, with instrumentation.

Here's an article:

http://www.codapedia.com/-article_355_.cfm