69210 or E/M inclusion rests on service and provider.
A patient comes to your office, complaining of ear pain. The physician then orders ear irrigation. Can you legitimately report 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) for the care? Ask yourself these medical billing and coding questions to keep your irrigation claims in the clear.
Was It Simply Irrigation?
At times a provider can clear the patient’s ear with basic irrigation, however occasionally he requires using more extensive measures. Before selecting CPT® code 69210, verify the level of service provided.
You cannot bill 69210 in case the provider only does irrigation. There has to be use of certain type of instrumentation to ‘dig out’ the impaction.
Code 69210 is for removal of impacted cerumen, not an ear irrigation. In case the physician carries out just an irrigation, it’s included in the E/M service."
Prior to submitting 69210, the provider’s documentation must evidently show that he removed impacted cerumen. Procedure notes must include the following details:
- That the physician carried out 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.).
In case you need to appeal the claim, the note you send must support the documentation stated above.
Medical Billing and Coding Tip: Some payers want you to append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M office visit code while you submit 69210 at the same encounter. Keep in mind that the E/M must only be billed when the work involved is distinctly identifiable and above and beyond the work involved in removing the impacted cerumen. The documentation of the E/M service must, preferably, be distinct from that of CPT® code 69210, and it must support the level of E/M service reported. Per CPT®, the E/M service may be stimulated by the symptom or condition (e.g. ear pain) for which the impacted cerumen removal was provided. Per se, dissimilar diagnoses are not needed for the E/M and 69210.
Who Carried Out the Service?
Before considering 69210, also confirm who treated the patient.
The physician should be performing the service to report 69210. Translation: Steer clear of CPT® code 69210 if the nurse cleans the ear.
Scenario: Imagine that a patient with ear pain sees the doctor, who recommends irrigation. The nurse performs the procedure after the physician sees the patient. The physician sees the patient again, to ensure that the ear canal is clean. Even though the physician saw the patient twice during the same office visit, he didn’t carry out the procedure. That implies that you’ll include the cleaning as part the E/M service, not a distinct procedure. CPT® code 69210 is intended to represent physician work.
