![]() As CMS cautioned in the Federal Register of J(page 37233), “It is our understanding that CPT code 69210 is to be used when there is a substantial amount of cerumen in the external ear canal that is very difficult to remove and that impairs the patient’s auditory function. In some situations, however, using this code according to the strict AMA definition may still not be appropriate. Since the removal of this “required physician work using at least an otoscope and instrumentation,” the procedure could be billable with code 69210. If so, then the wax actually does meet the strict AMA coding definition (listed above) for impacted cerumen. Before you give up too easily, ask the physician this question: “Why did you decide to remove the wax?” Chances are that the physician will tell you that the wax was getting in the way of performing an adequate otoscopic exam of the ear. If you ask the physician if the wax was “impacted,” he or she may indicate that, because the cerumen was not stuck tightly and filling the entire ear canal, the wax was not “clinically impacted.” But be careful you may be asking the wrong question. In this example, coders may make at least two interpretations: Such ambiguity exists in the application of the code 69210. ![]() Since real-life medical coding is governed by multiple entities-including the AMA, CMS, and multiple privatesector payors-there are many areas of coding where conflicting interpretations exist. The actual situation, however, is not quite so straightforward. Q.If the physician removes cerumen as part of the exam but the cerumen is not impacted, what code would be appropriate?Ī.A simplistic answer is that removing the wax is simply included in the emergency and management (E/M) code.
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