A patient complaining of ear pain visits your physician, who then orders an ear irrigation. Can you legitimately report 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) for the care? Before you decide on the code, ask yourself these three questions to keep your claims in the clear.
Question 1: Was Simple Irrigation Carried Out?
Sometimes a provider can clear the patient’s ear with basic irrigation, but sometimes he needs to use more extensive measures. Before choosing 69210, verify the level of service provided.
|Family Practice Coding Alert Your practical adviser for ethically optimizing coding, reimbursement, and efficiency for Family practices. Click here to buy the monthly Family Practice Coding Alert.|
“You cannot bill 69210 if the provider only does irrigation,” says Randa Cain, CPC, coding and charge capture supervisor with Martha Jefferson Medical Enterprises/Central Business Office in Charlottesville, Va. “There has to be use of some type of instrumentation to ‘dig out’ the impaction.”
“Code 69210 is for removal of impacted cerumen, not an ear irrigation,” adds Monica Gourley, CCS, outpatient/inpatient coder with Klickitat Valley Health in Goldendale, Wa. “If the physician does just an irrigation, it’s included in the E/M service.”
Before you report 69210, you need to prove with the provider’s documentation that he removed impacted cerumen. Procedure notes should include the following details:
- That the physician performed the procedure;
- That the ear had impacted cerumen;
- Why the physician removed the cerumen;
- How the physician removed the cerumen (what tools he used, such as a scoop or curette);
- The outcome (canal cleared, could visualize eardrum, etc.).
“If you need to appeal the claim, the note you send should...
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers