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Billing guidelines for cpt 69209

FOR AN IMMEDIATE LIBERATION A new CPT code, 69209, provides a specific billing code for the removal of affected earwax using irrigation/washing. For example, CPT 69210 (removal of affected earwax requiring unilateral instrumentation) 69209 requires a qualified physician or health professional to decide whether to irrigate or wash. However, unlike 69210, 69209 allows removal to be carried out by clinical staff. The criteria for the two codes CPT 69209 and 69210 are the same and documentation to support the medical necessity of the service is required to charge an identifiable service separately to an E/Mr. Each of them is considered one-sided and requires a 50 modifier to establish a bilateral procedure. Because CPT 69209 is new, many payers have not yet determined its status. Please consult a billing specialist before using it. The OtoClear Ear Irrigation Tip is a unique device specially designed for ear irrigation. The 3- OtoClear point in streaming directs water to the ear canal wall, away from the tympanic membrane, making irrigation safer. In addition to increased safety compared to single-flow irrigation tips, OtoClear's gentle TouchTM flare design improves patient comfort and helps reduce negative reactions. Dr Huberman, MPH, Bronx, NY said: I've been using the OtoClear irrigation system for over five years, and honestly believe that this is one of the best tools I have in the office... For more information on the OtoClear ear irrigation tip, call 800-551-7096 or visit . Published date: 12/11/2018 Elimination of affected earwax (69209, 69210, G0268) is only medically necessary when reported with a diagnosis of affected earwax (ICD-10 H61.2-H61.23) according to the CPT and HCPCS Level II manuals. As a result, CPT codes 69209, 69210 and G0268 will be refused when they are reported with any other diagnosis. Earwax can build up in the ear canal, which can lead to symptoms of discomfort, dizziness and hearing problems for which patients seek medical attention. In fact, the U.S. Family Physician's website tells us that ear, nose and throat removal is the most common ear, nose and throat (ENT) procedure performed in primary care. Coding for earwax removal depends on two factors: whether the earwax is affected; and if the earwax is affected, the method used to remove it. Unaffected - E/M Service CPT? tell us: For the removal of earwax that is not affected, see the service code E/M... such as new or established office patients (99201-99215), subsequent hospital care (99231-99233), etc. In other words, If the earwax is not affected, the removal is included in the reported documented assessment and management service (E/M) and cannot be billed separately. According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), earwax is affected if one or more of the following conditions are present: Cerumen impairs the examination of clinically significant parts of the external ear canal, the eardrum or the condition of the middle ear; Extremely hard, dry and irritatingly irritating earwax symptoms such as pain, itching, hearing loss, etc. Earwax is associated with foul smell, infection or dermatitis; or obstructive, hearty earwax cannot be removed without magnification and multiple instrumentation requiring doctor's qualifications. THE CPT? Changes 2016: An Insider's View by WADA confirms: The impacted earwax is generally extremely hard and dry and accompanied by pain and itching. Affected earwax clogging the external ear canal and tympanic membrane can cause hearing loss. Method determines coding for impacted removal If the earwax is affected, it can be removed by one of two general methods: washing (irrigation) or instrumentation. For washing removal, the correct code is 69209 Removal touched earwax using irrigation/washing, unilateral. For removal using instrumentation (e.g., forceps, curette, etc.), turn instead to 69210 The removal has had an impact on the earwax requiring unilateral instrumentation. CPT? Changes 2016: An Insider's View: Code 69210 captures only the direct method of removing earwax using curettes, hooks, forceps and suction. Another less invasive method uses a continuous flow of low fluid pressure (e.g., salt water) to gently loosen the affected earwax and rinse it ... Code 69209 allows separate reports of the method of irrigation or washing of the removal of the affected earwax... You can report a single unit of 69209 or 69210 (never both), per ear treated. As an example of appropriate reports for 69209, CPT? Changes 2016: An Insider's View provides the following: A 7-year-old comes for his child exam. He fails his hearing screen in his left ear. On examination, the doctor is unable to see the tympanic membrane due to earwax impaction. An order is placed for the nurse to irrigate the ear. Bilateral Services Both 69209 and 69210 are unilateral procedures. To remove the persoted earwax from both ears, attach the 50 Bilateral Procedure to the appropriate code. In the above example of the 7-year-old, if irrigation occurred in both ears, the appropriate coding is 69209-50. When billing Medicare payers, different bilateral rules apply for 69210. The relative value record of the 2016 National Health Insurance Physician Fee Appendix assigns 69210 a bilateral indicator 2. This means that, for Medicare payers, the units of relative value assigned to 69210 are already based on the procedure performed as a bilateral procedure. Contrary to the CPT? instructions, the Centers for Medicare and Medicaid Services (CMS) allow us to declare a single unit of 69210 for a Bilateral. CMS allows us to charge a bilateral procedure for the removal of earwax by washing using 69209-50. Finally, note that some payers may stipulate that an advanced practitioner's competency is required to report the removal of the affected earwax (i.e., payers may require a physician to provide 69209, 69210). Ask your individual payers to be certain of their requirements. John Verhovshek, MA, CPC, is Editor-in-Chief of APAC and a member of the N.C. Local. John Verhovshek, MA, CPC, is Associate Editor at AAPC. It covers medical coding and billing, health care policy and medical affairs since 1999. He is an alumnus of the York College of Pennsylvania and Clemson University. Cerumen Removal Coding Depends on Impaction, Method was last modified: March 1, 2016 by John Verhovshek Irrigation/Washing: Payers will generally not cover simple, un impacted removal of earwax. This work is included in e/m services and should not be reported separately with e/m services when performed. If the affected earwax is removed only by irrigation or washing, use CPT 69209. CPT 69210 should NOT be reported for washing. Requirements to report earwax removal: The CPT defines earwax as being affected if one or more of the following conditions are present: - earwax interferes with the examination of clinically significant parts of the external auditory canal, the tympanic membrane (unable to see the entire tympanic membrane) or the condition of the middle ear; Extremely hard, dry and irritating earwax causes symptoms such as pain, itching, hearing loss, etc. Earwax is associated with a foul smell, infection or dermatitis; Obstructive and copious earwax cannot be removed without magnification and multiple instruments requiring the skills of a physician or non-physician practitioner. Instrumentation A key factor in determining whether code 69210 should be reported is the instruments used to remove the affected ear wax. In this context, instrumentation is defined as the use of an otoscope and other instruments such as wax curettes, metal loops or suction as well as specific auditory instruments (e.g., cup forceps, right angle hook). Accompanying documentation should indicate the equipment required to deliver the service. Unilateral Procedure Descriptors of Codes 69209 and 69210 indicate that these would be unilateral codes. For bilateral removal of impacted cerumen, report these codes with Modifier 50, bilateral procedure, attached. Note: Medicare does not authorize the use of Modifier 50 for removal of the affected earwax. To report to Medicare use the unilateral code without changing whether it is carried out unilaterally or bilaterally. Requirements for reporting the removal of earwax affected by an E/M on the same DOS When de reporting a visit E/M uandu cerumen abduction on the same date of service, the following criteria must be met: - The main reason for the patient's visit was distinct from the removal of the earwax - anotoscopic examination of the tympanic membrane is not possible due to the impaction - Removal of the Affected requires the expertise of the physician or non-physician practitioner - The procedure requires a lot of time and effort, and all of the above criteria are clearly documented in the patient's medical record Modifier -25 When all of the above requirements are met, an applicable E/M and 69209 OR 69210 can be reported together and the appropriate modifier , -25 (significant and identifiable separately and the management service by the same physician on the day of the procedure or another service) must be attached to the E/M. Visiting Code It is imperative that the clinic's notes demonstrate that the e/m and the removal of the earwax are separate services. The unaffected cerumen CPT guidelines state: For the removal of earwax that is not affected, see the service code E/M... such as new or established office patients (99201-99215), subsequent hospital care (99231-99233), etc. In other words: if the earwax is not affected, the removal is included in the documented E/M service reported and cannot be billed separately. Charged.

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