Billing and Coding Tips for 69210 — Manual Removal of Impacted Cerumen

Billing Tips for 69210

Tips provided by Don Self & Associates, Inc.

When billing Medicare for 69210, a provider should be cautioned that Medicare, Blue Cross and other carriers do NOT consider lavage, or washing of ears, to be the same as described in the CPT codebook or Medicare Carrier Manual as 69210.

Often, depending on the provider, ear lavage is not separately billable and can fall within the scope of the E&M (evaluation and management) visit code.

69210 requires manual removal of IMPACTED cerumen. A Medicare auditor will be looking for specific details in the progress note, including:

  • What device, instrument, curette, suction device or equipment was used in the manual removal of the impacted wax.
  • The word magnification or audioscope or by what means magnification was achieved.
  • The word impacted must be used. The semantics are important. The use of diagnosis code 380.4 is not sufficient by itself – as an auditor will look for the word “impacted”.

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This information was provided by the professionals at:

Don Self & Associates, Inc.
Medical Reimbursement Consulting
305 Senter Avenue, Whitehouse, TX 75791
Phone: (903) 372-7529 Fax: (480) 247-5650
e-mail: donself@donself.com
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