Cms limits payment for cpt code 69210 to earwax removal during visits that meet all of the following criteria. The provider removed the additional charge for the cpt 69210 because it was only removed from one ear and unsuccessful in the other ear. Ama cpt assistant 2016 issue 1 january removal of impacted cerumen january 2016 january 2016 pages 78 removal of impacted cerumen in the current procedural terminology cpt 2016 code set, code 69209 was added to the auditory system subsection to report the removal of impacted cerumen earwax using irrigation or lavage. Cerumen removal unsuccessful medical billing and coding. Billing and reimbursement for cpt code 69210 or hcpcs code g0268 is limited to clinical. Dec 10, 2015 only a few areas do not have any changes this year there are no deleted or changed modifiers and there are no changes to the anesthesia chapter of cpt. We recommend that you submit this under cpt code 69210 for potential reimbursement. Earwax removal coded as surgery during routine visit forum. If we perform this service, do we need to bill medicare even though they will not reimburse us for this procedure. Cpt code 92504 this is a separate procedure this has an xxx global designation 0. Auditing for cerumen removal codes 69209, 69210 findacode.
Only a few areas do not have any changes this year there are no deleted or changed modifiers and there are no changes to the anesthesia chapter of cpt. How does one determine that the cerumen is actually impacted so that code 69210 may be used for removal of the cerumen. Can you bill for a 69209 removal of cerumen using irrigationlavage when it is performed by a medical assistant. Ama cpt code set revision process, ama ruc process, and aaohns new. To get what you deserve for cerumen removal, our experts say you should implement. While there are many noteworthy cpt coding changes in 2016, the focus of. Earwax removal coded as surgery during routine visit. The physician who saw the patient billed 992 office or other outpatient visit. Other updates for this edition include detailed information on new and revised cpt codes for 2016 including prolonged clinical staff time removal of impacted cerumen with irrigation or lavage revision of photoscreening services new chapter on enhanced quality and pay for performance expanded coding resources including articles for the aap. Auditing for cerumen removal codes 69209, 69210 finda. The physician may report current procedural terminology cpt code 69210 for removal of impacted cerumen. The provider must still document that the cerumen was impacted in order to bill for the service, but removal does not have to be performed by a physician.
Dont let confusion over coding guidelines wreck your next cerumen removal claim. September brings football season, the colors of fall and your first glimpse of code updates that will affect how you file claims the following year. Someone told me to bill an em code like 99212 or 99202, instead of 69210 when removing impacted cerumen with instrumentation. This code will allow you to code for encounters when your provider removes impacted cerumen using irrigation or lavage. The american medical association ama has released its document showing changes for cpt 2016. Impacted cerumen typically is extremely hard and dry, usually is accompanied by pain and itching, and can lead to hearing loss. Em code with cerumen removal medical billing and coding. Coding for cerumen removal american academy of pediatrics. Coding corner american academy of otolaryngologyhead and. Just like placing a splint is a surgical code but patients get confused and say i didnt have surgery. Oct 17, 2016 cpt guidelines tell us, for cerumen removal that is not impacted, see em service code such new or established office patient 9920199215, subsequent hospital care 9923199233, etc.
The rules that apply to the two cerumen removal codes now available for use mean that auditors will need to scrutinize the documentation closely in order to ensure codes are being used correctly. Coding for cerumen removal aap pediatric coding newsletter. Rejections for claims for removing impacted cerumen. May 09, 2018 removal of cerumen wax from the ear forms a significant part of the workload of an otolaryngologist and is, therefore, an essential skill to master. Jan 17, 2017 cerumen naturally migrates out of the ear canal assisted by jaw movement but may occlude or become impacted in the canal, sometimes causing hearing loss, tinnitus, itching, pain, or cough or impeding assessment of the tympanic membrane and middle ear structures. The current procedural terminology cpt book is published annually, and for.
You may report 69210 removal impacted cerumen requiring instrumentation, unilateral if instrumentation is used to remove impacted cerumen. Be sure you document the specific type of instrumentation used e. As for everything else, grab your 2016 cpt code book or digital version and follow along. Its been active for over a month now, but new code 69209 removal impacted cerumen using irrigationlavage, unilateral has stymied many pediatric practices across the country. Cpt coding and billing for a bilateral cerumen removal. Coding for removal of impacted cerumen 69210 journal. Removal of impacted cerumen one or both ears by physician on same date of service as audiologic function testing. As an alternative, if you have an individualized coding or billing question, and you are a member of the american college of surgeons acs, you can access the acs coding hotline at 8002277911.
The ama did not make changes to cpt code 69210, for removal of impacted cerumen using instrumentation, other than to clarify that 69209 cannot be reported with 69210 when performed on the same ear. Endorsed, august 2016 the updated guideline, earwax cerumen impaction, was developed by the american academy of otolaryngologyhead and neck surgery and endorsed by the american academy of. If earwax is impacted it may be removed by one of two general methods. Cerumen impaction is a condition in which earwax has become. Dec 17, 2015 that said, it is never appropriate to report 69990 with 69210 because 69990 is meant for microsurgical techniquesmicrodissection. Alternatively, cerumen removal may increase the complexity of the visit. If any one or more of the following are present, cerumen should be considered impacted clinically. As an otolaryngology coder, youre probably all too familiar with the underlying coding processes behind a cerumen removal office visit.
Sep 12, 2011 as an audiologist, i am unclear about billing for cerumen removal. Code 69210 only captures the direct method of earwax removal utilizing curettes, hooks. Part b news use new cerumenremoval code 69209 for fluid. Medical policy impacted cerumen removal guidelines this policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder contract. New coding breakthrough for cerumen removal infectious diseases in children, april 2016 one of the new 2016 cpt codes that should see a great deal of use in pediatricians offices is the code.
One of the new 2016 cpt codes that should see a great deal of use in pediatricians offices is the code that entails the removal of impacted cerumen using. American academy of audiology aaahome sso redirect. The cpt changes clinical example is for a nurse but my providers feel that it should be able to be billed for when a nurse performs it. As a result of his examination of the affected ear, the doctor asked the ma to remove excessive ear wax 69210, removal impacted cerumen separate procedure, one or. Cpt guidelines tell us, for cerumen removal that is not impacted, see. Coding for removal of impacted cerumen 69210 journal of. Coding for cerumen earwax removal is going to get a whole lot easier in 2016. Physicians will have another way to report removing ear wax in 2016 now that surgical code 69209 removal impacted cerumen irrigationlavage, unilateral joins higher level 69210 removal impacted cerumen requiring instrumentation, unilateral in the auditory system section.
Cpt was developed by the american medical association ama to provide. The new code, 69209 removal impacted cerumen using irrigationlavage unilateral has no work value rvus. Use 69209 for less invasive cerumen removal the coding institute. This response is based on the best information available as of 121715. Impacted cerumen obstructing the external auditory canal and tympanic membrane can lead to hearing loss. As with most of the procedural codes, you should not routinely report an em code for the preprocedural evaluation that your clinician performed. Procedure code 69209, 69210, g0268 ear wax removal. However, despite being one of the most common reasons for an ear, nose, and throat ent patient encounter, cerumen removal remains one of the most miscoded areas of the specialty. Ive looked in the cpt book for codes and it looks like cpt 6158061619 are just what im looking for.
The cpt code for cerumen removal is a surgical code. Minimal cerumen in the left ear is also removed by lavage. We are thinking about starting an endoscopic skull base surgery program and doing skull base procedures via an expanded endonasalendoscopic approach. Impacted cerumen removal is the extraction of hardened or accumulated cerumen ear wax from the external auditory canal by mechanical means, such as irrigation or debridement. Cerumen removal coding depends on impaction, method aapc. Impaction means the cerumen is hard and dry and may block the providers ear exam. The keys to assigning 69210 are knowing whether the earwax was impacted, how to report incidentto removal, and when you can separately submit codes for the procedure and office visit. However, general practitioners, emergency department staff, nurses, audiologists, audiological physicians, and alternative medicine practitioners may all be confronted with the scenario of exce. We have started receiving rejections for ed claims when the services involves removing impacted cerumen. Cerumen accumulation can be asymptomatic, but it can also cause problems such as impaction, hearing loss, pain, dizziness, and tinnitus.
Listen up for safe ear irrigation article nursingcenter. The code changes impacting emergency medicine are listed below. Cpt codes general current procedural terminology cpt is a listing of descriptive terms and identifying codes for reporting medical and health care services. Bank on this definitive coders guide to cerumen removal. With this, primary care providers now have a code that better reflects how cerumen is removed. It must be impacted and certain instruments must be utilized in order to qualify for the use of this code. Curettage can also be used for foreign body removal. Back pesky cerumen impaction codes february 15, 2016 andria jacobs. A new cerumen impaction code was revealed at the annual cpt ama symposium. Removal of impacted cerumen one or both ears by physician on same date of service as audiologic function testing here are a few criteria that need to be met when reporting procedure code. For the purpose of accurate coding, the ama defines impacted cerumen in the july 2005 cpt assistant as follows. Going forward these are just some of the changes to be aware of in 2016.
This years cpt updates include 140 codes added, 2 revised, and 91 deleted codes. Feb 1, 2016 medicaid reimbursement for the removal of impacted cerumen using cpt procedure, nys medicaid considers cpt code 69210 as a bilateral ioce summary of data changes data changes. Removal of impacted cerumen one or both ears by physician on same date of service as audiologic function testing hcpcs code g0268 for removal of impacted cerumen one or both ears by physician on same date of service as audiologic function testing as maintained by cms falls under miscellaneous diagnostic and therapeutic services. The np removed the cerumen with a curette after irrigation from one ear, but it was not removed from the other ear. The code for removing impacted cerumen is a surgical cpt code, 69210. Cpt code 69210 removal procedures on the external ear. Before this code, a problem stemmed from coding guidelines requiring documentation of impacted cerumen before coders could submit 69210 removal impacted cerumen requiring. Removal of impacted cerumen january 2016 cpt assistant.
Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. Although cpt guidelines clearly state that a surgical cerumen removal is a unilateral procedure, many payers have their own policies that contradict cpt guidance. The current procedural terminology cpt book is published annually, and for 2016, there are 92 deletions, 4 revisions, and 140 cpt code additions, totaling 366 changes. The new code is 69209, described as removal of impacted cerumen using irrigationlavage, unilateral. Jul 27, 2015 analysis of the 2015 medicare physician fee schedule mpfs, including. Pediatric care online red book online pediatric patient education aap toolkits. New coding breakthrough for cerumen removal healio. Because the cpt manual describes the procedure as inherently unilateral, each instance of 69210 would be billed on a separate claim line with applicable modifiers. Jun 02, 2016 because the mue for cpt code 69209 is 2, you would append modifier 50 to report that the ear lavage was performed in both ears if both ears had impacted cerumen. The 2016 medicare national physician fee schedule relative value.
In fact, the american family physician website tells us that cerumen removal is the most common ear, nose, and throat ent procedure performed in primary care. Removal of impacted cerumen january 2016 subscription required. Use new cerumenremoval code 69209 for fluidbased drainage. Mar 01, 2016 cerumen ear wax can build up in the ear canal, which may lead to symptoms of discomfort, dizziness, and impaired hearing for which patients seek medical care. For removal by lavage, the correct code is 69209 removal impacted cerumen using irrigationlavage, unilateral. Aug 03, 2016 cpt considers prolonged service codes 9935499357 as addon codes and therefore they should not be reported without the appropriate primary code. At the present time, if removal of impacted cerumen is necessary in order to complete audiological testing, then medicare will pay for it but because it is not a diagnostic procedure audiologists are not eligible to.
If the earwax isnt impacted, removal is not separately billed and is included in the documented em service reported. How the 2016 cms coding changes will affect emergency. It can be submitted under cpt code 69200 for potential reimbursement. You have to document the fact that the cerumen was impacted and required the physician to use instrumentation to remove it before you can report 69210 removal impacted cerumen requiring. Steven white there currently is no code for cerumen management. For clinical feedback on your inquiry, please consider posting on entconnect. An insiders view confirms, impacted cerumen is typically extremely hard and dry and accompanied by pain and itching.
Cpt 0406t and 0407t and how to use the updated cerumen removal code cpt 69209. Until cpt 2016, physicians had two choices when coding for most cerumen. The medicare coverage database contains all national coverage documents, local coverage determinations lcds, and articles. In 2016, cpt, published by the american medical association ama, is celebrating its 50th birthday with 10,000 cpt codes. In 2016, you get a new code that better reflects how primary care providers remove cerumen. Want to keep your cerumen removal coding out of trouble. The codes listed above should only be billed for the removal of impacted cerumen the american medical association cpt assistant october 20 provides four considerations, each of which defines impacted cerumen. There is a new code 69210 to bill for removal of cerumen. The american academy of otolaryngology head and neck surgery aaohns states that cerumen removal requires mechanical manipulation of the external auditory canal and such manipulation may result in traumatic andor inflammatory lesions to the external auditory canal. Feb 11, 2014 medicare turns deaf ear to cpt changes on cerumen removal medicare payment policy doesnt always match the american medical associations current procedural terminology cpt. Billing for cerumen removal under medicare kim cavitt steven. Dec 10, 2015 physicians will have another way to report removing ear wax in 2016 now that surgical code 69209 removal impacted cerumen irrigationlavage, unilateral joins higher level 69210 removal impacted cerumen requiring instrumentation, unilateral in the auditory system section. Medical role in cerumen removal this is more content.
When the first edition of the current procedural terminology cpt was released in 1966, there were only 3,554 codes. Cpt assistant on cerumen removal as mentioned by another, you will probably want to check the cpt assistant that qualifies cerumen removal. In addition, the payment update for 2016 and each subsequent year through 2019 will also be medicare payment, and audiology payment and coding rules. The american medical association introduced current procedural terminology cpt code 69209, removal impacted cerumen using irrigationlavage, unilateral, to rectify that situation. Cpt is introducing 69209 removal impacted cerumen using irrigationlavage, unilateral. Nov 22, 2015 cpt 2016 code removal cerumen via irrigation. The medicare coverage database mcd overview page provides general information about the application, such as its intended purpose and the types of content that can be found here. As most pediatric coders are aware, payment for cerumen removal doesnt come easily. Cerumen impaction is diagnosed in 10% of children and 5% of adults. Method determines coding for impacted cerumen removal. Use new cerumen removal code 69209 for fluidbased drainage. Listen up for these tips for reporting cerumen disimpaction. Billing for cerumen removal under medicare kim cavitt. Medicare turns deaf ear to cpt changes on cerumen removal fpm.
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