If your provider starts out with irrigation and then needs to switch to instrumentation to dig the wax out of that ear, report the code that represents the higher intensity procedure. If he uses any instruments to remove the impacted cerumen, you report 69210 Removal impacted cerumen requiring instrumentation, unilateral for the procedure. Simple irrigation with a bulb syringe with or without chemical softeners is often effective and generally does not require a physician's skill. Fast Track Your Coding With Internal Medicine Coder! Of course, the physician documentation should clearly demonstrate the presence of impacted cerumen, as defined above. For example, if a patient is given code R030 for elevated blood pressure reading, without diagnosis of hypertension, then the patient would have a questionable admission, since elevated blood pressure reading is not normally sufficient justification for admission to a hospital. Guidelines are typically updated or reaffirmed every 3 to 5 years.
She has a special love for medical language and terminology. Get Familiar With the Causes Impacted cerumen or wax in the ear can affect both children and adults. In the example above of the 7-year-old child, if irrigation occurred in both ears, appropriate coding is 69209-50. Extraction requiring methods beyond simple irrigation or removal by Q-tip or cotton-tipped applicator may require a physician's skill. Note: dots are not included. Impacted cerumen can also impede the evaluation and management of other otologic conditions.
When billing Medicare payers, different bilateral rules apply for 69210. For further information on reimbursement guidelines, please see Administrative Policies on the Blue Cross Blue Shield of North Carolina web site at www. It provides lubrication and acts as a vehicle for the removal of contaminants away from the tympanic membrane and prevents dessication of the epidermis. The definition of impacted cerumen is met according to Section I of this policy. An order is placed for the nurse to irrigate the ear. This code cannot be used for irrigation only.
If it is unilateral, there is no specific diagnosis code to help identify whether the impacted cerumen is present in the right or the left ear. Note: procedure codes 69209 and 69210 describe a unilateral procedure. Cases requiring methods beyond simple irrigation or removal by Q-tip or cotton-tipped applicator may require a physician's skill. Method Determines Coding for Impacted Cerumen Removal If earwax is impacted it may be removed by one of two general methods: Lavage irrigation or instrumentation. We respond to notices of alleged copyright infringement and terminate accounts of repeat infringers according to the process set out in the U.
Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition. Depending on the case, different methods are used to remove impacted cerumen. Note also that the Correct Coding Initiative bundles 69209 into 69210. These summarizations of the original, full-text guidelines never omit or alter important information. When removal of impacted cerumen is not covered Simple cerumen removal when performed by the physician or office personnel e. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. Let us know in the comment box below.
Cerumen, or ear wax, is the product of desquamated skin mixed with secretions from the adnexal glands of the external ear canal. The actual situation, however, is not quite so straightforward. If irrigation is not an option or if it fails to remove the cerumen, the physician can remove the wax with a vacuum device or curette a small, scoop-shaped instrument. By using our Services, you agree that www. . The medical disorders treated by our physicians are among the most common that afflict all Americans, young and old. Many more customized features come with Internal Medicine Coder — About Susan taught health information and healthcare documentation at the community college level for more than 20 years.
Paramount cannot reimburse audiologists for procedure code 69209, 69210 or G0268 under any circumstances. Irrigation is the most common method of removing impacted cerumen; the process involves washing out the ear canal with water from a commercial irrigator or a syringe with a catheter attached. You know that certain requirements must be met before you can report removal of impacted cerumen, but don't overlook the associated diagnoses. Bilateral Services Both 69209 and 69210 are unilateral procedures. An Excludes2 note indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time.
Procedure G0268 is non-covered for Advantage. Query your individual payers to be certain of their requirements. Less common causes include an overproduction of earwax or an abnormally narrow ear canal that tends to trap the wax. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Is it appropriate to bill the 99211 with the 69210? Got any tips for dealing with reporting these tricky cerumen removal procedures? As an urgent care center, can we also bill an office visit with a 25 modifier and a 69210 on the same day of service, especially if the doc examines the patient first and then determines that he needs an ear wash? However, Paramount can pay audiologists only for medically necessary diagnostic testing, which is considered to include any incidental cerumen removal by the audiologist. Impacted cerumen obstructing the external auditory canal and tympanic membrane can lead to hearing loss.
Symptoms: Partial loss of hearing is the most important symptom of cerumen impaction. The documentation in the medical record must clearly reflect that the service required significant effort and time of the physician or non physician practitioner. It is recognized that audiologists' education, experience or practice may include or require techniques of cerumen removal. Before implement anything please do your own research. Select Billable Codes to view only billable codes under H61. A type 1 Excludes note is a pure excludes. You'll find your choices in the H61.
The inclusion terms are not necessarily exhaustive. Also, ask him to specify which ear is affected if the condition is unilateral. If the physician removes cerumen as part of the exam but the cerumen is not impacted, what code would be appropriate? Impacted cerumen removal 69209, 69210 does not require prior authorization for Advantage. Since no physician work was required, you should not use code 69210. Forced irrigation with a metal hand-held syringe or an electric oral jet irrigator may be necessary in some cases. Claims submitted with a -50 modifier will deny.