Can You Hear Me Now?

September 1, 2007

We are trying to research how to bill for an ear wash for wax DX 380.4. I have so far come to procedural code 69210, removal of impacted cerumen. Our physician is using a special syringe to manually remove the wax from the patient’s ear. Does this service comply with the procedure 69210? Could you please provide us with full details on how to bill for an ear wash and the known reimbursement rate?

Question: We are trying to research how to bill for an ear wash for wax DX 380.4. I have so far come to procedural code 69210, removal of impacted cerumen. Our physician is using a special syringe to manually remove the wax from the patient’s ear. Does this service comply with the procedure 69210? Could you please provide us with full details on how to bill for an ear wash and the known reimbursement rate?

Answer: CPT does not specify what the term “removal” refers to, whether swab, irrigation, or otherwise. However, according to CMS (Medicare), payment for cerumen removal is made only when the following criteria are met:

  • The service is the sole reason for the patient encounter;

  • The service is personally performed by a physician or nonphysician (NP, PA, CNS);

  • The service is provided to a patient who is symptomatic; and

  • The documentation illustrates significant time and effort spent performing the service.

CMS also defines routine cerumen removal as the use of softening drops, cotton swabs and/or cerumen spoon and is not paid separately since it is considered incidental to the office visit.

Check with your commercial payers to determine their policies and payments. You’ll also need to check your own fee schedules.

Bottom line: this will be bundled most of the time no matter how you do it, but you have the right code.