The CPT codes for Cerumen removal are CPT 69209 and CPT 69210. The description and billing guide for Cerumen removal CPT codes 69209 and 69210 can be found below.
CPT has updated the 69210 CPT code for Cerumen removal to reflect the removal of impacted cerumen that requires instrumentation on one side.
The 69210 CPT code refers to a procedure that removes impacted cerumen from one or both ears as a stand-alone treatment. Use the same code only once to indicate that the process was successful, whether to remove impacted cerumen from one or both ears.
CMS, however, does not share this viewpoint. According to CMS, “the physiologic processes that cause cerumen impaction are likely to affect both ears,” so treatment can give to both ears simultaneously. CMS provided no evidence or sources to support this claim.
As a result, CMS reiterated that only one unit of CPT 69210 could pay the bill when provided bilaterally. Therefore, the CPT codes for Cerumen removal can be reported with CPT 69209 and CPT 69210.
Cerumen will consider “impacted” for the Current Procedural Terminology (CPT) when it does one or more of the following: prevents examination of clinically significant areas of the external auditory canal, the tympanic membrane (avoiding the ability to see the entire tympanic membrane), or a condition affecting the middle ear; is harsh, dry, or irritating and causes symptoms such as pain, itching, hearing loss, etc.
CPT 69209 and CPT 69210 describe as one-sided code in their descriptions. If you’re filing for treatment of bilaterally impacted cerumen, you should add the modifier 50, Bilateral Procedure, to these codes.
Similarly, the 69210 CPT code can improve to reflect the code’s inherent unilaterality. If you need to remove impacted cerumen from both sides, report procedure CPT code 69210 with the modifier 50, Bilateral Procedure.
Third, a medical professional, either a doctor or a non-medical practitioner, must manually remove the impacted cerumen.
The procedure is tedious and time-consuming. In your clinical notes, you must document that the E/M and cerumen removal are two different services and that all criteria for the applicable E/M service should meet. The appropriate ICD-10 diagnosis code must include in the claim.
Description Of The CPT Codes For Cerumen Removal
CPT code 69209 is the Current Procedural Terminology (CPT®) code for unilateral removal of impacted cerumen. This code is officially described as: “Removal impacted cerumen using irrigation/lavage, unilateral.”
CPT 69210 can also be used as a Cerumen removal CPT code and was revised in CY 2014 to clarify that the code is unilateral and that instrumentation is required for the procedure to be reportable (which is covered in more detail below). Cerumen removal necessitates more than simply rinsing or leaving the ear.
The 69210 CPT description reads: “Removal impacted cerumen requiring instrumentation, unilateral.”
Insurance frequently does not cover simple, non-impacted earwax removal. The E/M service covers this work, so an E/M code must report. Furthermore, CPT 69210 should not register if earwax could only remove through irrigation or lavage.
When writing the use of irrigation or lavage, there is a brand new CPT code 69209 that only represents practice costs.
This term refers to the removal of impacted cerumen in a specific area. The presence of cerumen makes examination of the tympanic membrane, middle ear, and external auditory canal difficult, all of which are clinically important.
Pain, itching, hearing loss, and other symptoms could cause by extremely dry, hard cerumen. Obstructive, copious cerumen of any consistency cannot remove without magnification and instrumentation that requires physician expertise; this cerumen could associate with odor, infection, or dermatitis.
The methods used to remove the impaction must be considered when deciding whether to report the 69210 CPT code for cerumen removal.
For example, using an otoscope and other ear instruments such as wax curettes, wire loops, or suction cups is called instrumentation (e.g., cup forceps, right angle hook). The tools needed to complete the service should specify in the documentation.
Using a microscope is not required for the 69210 CPT code. However, if the operating microscope can use to remove cerumen, CPT code 92504, Binocular microscopy (separate diagnostic procedure) can be reported in addition to CPT code 69210.
Finally, audiologist-assisted cerumen removal can not cover by Medicare. Only the physician should submit the 69210 CPT code claim for Medicare patients who have their cerumen removed on the same day as their audiology testing.
An unaffiliated audiologist cannot file a 69210 CPT code for Cerumen removal. Some insurance companies may require HCPCS code G0268.
Does Medicare Cover The CPT Codes For Cerumen Removal?
Medicare does not cover medical care, including impacted or non-impacted cerumen removal by a licensed audiologist acting within the scope of practice.
An audiologist’s ability to remove cerumen depends on various factors, including the patient’s insurance coverage, the severity of the cerumen buildup, and the audiologist’s specific area of practice.
The state’s audiology licensing laws and regulations can assist audiologists in determining whether cerumen removal is within their scope of practice.
According to CPT Assistant (July 2005), cerumen must meet one or more criteria and consider “impacted.” Cerumen, for example, “prevents a thorough examination of the external auditory canal, tympanic membrane, or middle ear condition.”
Cerumen is exceptionally thick, dry, and irritable, resulting from an infection, dermatitis, or a foul smell; the source of discomfort, itching, hearing loss, and so on. Obstructive, excessive cerumen must remove with various tools and under close inspection.
A licensed audiologist may practice within the confines of their state’s audiology licensure laws, but Medicare does not consider them medical professionals and thus does not pay for their services.
Private billing to a Medicare recipient by an audiologist for treatment-related services, such as the clearance above of impacted cerumen, is possible.
If the Medicare recipient requests that you submit a claim to Medicare for the removal of impacted cerumen, use CPT code 69210 and the appropriate modifier.
Patients with Medicare should not charge an additional fee for the part of the audiology test procedure that involves the removal of cerumen that is unaffected by the methods described above.
In these cases, otoscopic examination reveals that, despite its apparent presence, the cerumen in the ear canal could not impact.
The tympanic membrane can be seen as a whole or in sections. For effective removal of this type of cerumen, magnification, swabs, curettes, irrigation, suction, and a softening agent are all required.
Cerumen must remove to obtain an accurate reading on an audiology test. CPT code 69210 should not be reported if the cerumen is unaffected (removal of impacted cerumen).
How To Report Modifiers With The Serumen Removal CPT Codes
Use CPT code 92700, unlisted otorhinolaryngological service or procedure, to remove non-impacted cerumen, such as when inserting earphones will use, to manage hearing aid feedback, or when a deep-fitting aid can use.
If you want to avoid using CPT 69210, which designs for impacted cerumen removal, consult the CPT Assistant (which applies to all payors).
If the cerumen remove, the documentation (which may include a copy of the video otoscope image) should consist of the reason for the appointment, the type, and location of the cerumen within the canal, whether it will impact, and the method(s) used to remove it.
Because the CPT Assistant, rather than Medicare, provided the direction, all payers are subject to the same restrictions on its use. It would help if you investigated whether the removal of impacted or non-impacted cerumen is covered by your third-party agreements and payers as soon as possible.
An E/M service cannot add to a doctor’s visit solely to remove symptomatic impacted cerumen. Adding this modifier to the correct unilateral procedure code as a single line entry on the claim form indicates the procedure was performed on both sides, as required by the current coding manual (two times).
Modifier 50 can be added to bill surgical procedures or services in the CPT code section for radiology (10040-69990) when performed on both sides of the body. The same doctor can perform the following procedure.
Modifier 50 can not be used to bill Medicare for the CPT code for impacted cerumen. The preceding could document the patient’s medical record, and removing the impacted cerumen is a complex procedure that necessitates the treating physician’s or non-physician practitioner’s expertise.
As a result, a report with an applicable E/M and CPT 69209 OR CPT 69210 is possible. The E/M and cerumen removal must document separately in the patient’s medical record.
Cerumen removal CPT code 69210 should only be used for billing and reimbursement when the procedures performed necessitate a physician’s level of training and experience.
Insurance companies frequently deny even the most basic ear cleanings.
Cerumen removal CPT 69209 should only be reported in the case of lavage or irrigation to remove the impacted wax. Do not report CPT 69210 because it is NOT for lavage and won’t be reimbursed.