Coding & Compliance Newsletter - January 2009

January 2009 News

Tips for Billing Cerumen Removal (69210, G0268)

Physicians see a lot of patients who have ear wax problems, which take time and effort by the physician to remediate, but must be clearly documented in order to bill for cerumen removal.

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published the following regarding code 69210:

“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 (e.g., cup forceps, right angles). Accompanying documentation should indicate the time, effort, and equipment required to provide the service.”

It is easy to identify when a physician did or did not perform the service, as well as what type of equipment is used. However, it is not so simple to determine what constitutes “impacted” ear wax. The AAO-HHN established the following clinical definitions, noting if any one or more of the following are present, cerumen should be considered “impacted” clinically:

Visual considerations: Cerumen impairs exam 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 instumentations requiring physician skills.
Code 69210 can be billed in addition to an office visit, if a significant and separately identifiable service is performed. When this occurs, add modifier -25 to the E&M service. An example would be that the patient has a medical condition that relates to the ear: otalgia, otitis media, dizziness, vertigo, hearing loss or conditions relating to the tympanic membrane or auditory ossicles.

4 Tips to successfully obtain payment for cerumen removal:

When billing for cerumen removal and an E&M service, report different diagnoses (when appropriate, 380.4 for impacted cerumen removal and the diagnosis code associated with the E&M code).
Bill G0268 to Medicare only when a physician, not an audiologist, performs the procedure. Medicare created code G0268 when the removal of impacted cerumen, one or both ears, is performed by the physician on the same date of service as audiologic function testing.
Check the Correct Coding initiative to see if the removal of cerumen is bundled with more extensive procedures.
Do not bill code 69210 unless the otolaryngologist did more than "routine cerumen removal."

Remember to check your local carrier guidelines if you are not being paid for code 69210 or G0268.

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If you have any questions or need additional information regarding this article please contact Cindy Tipton at Cindy_Tipton@www.med3000.com