How do you bill for cerumen removal?

If the patient has pain in the external ear as his/her only complaint and the removal of cerumen addresses that complaint, one should bill only for removal of the cerumen, CPT code 69210.

For removal by lavage, the correct code is 69209 Removal impacted cerumen using irrigation/lavage, unilateral. For removal using instrumentation (e.g., forceps, curette, etc.), turn instead to 69210 Removal impacted cerumen requiring instrumentation, unilateral.

Subsequently, question is, how do you bill bilateral procedures? Bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate CPT or HCPCS code. The procedure should be billed on one line with modifier 50 and one unit with the full charge for both procedures.

Then, does CPT 69210 need a modifier?

CPT® considers this procedure to be unilateral. CPT® states, “For bilateral procedure, report 69210 with modifier 50.” Medicare will pay the same amount for 69210 whether it is performed on one ear or two, even though the CPT® descriptor stipulates it is unilateral.

How much does it cost to get your ears cleaned?

On MDsave, the cost of an Earwax Removal ranges from $90 to $231. Those on high deductible health plans or without insurance can shop, compare prices and save.

Does health insurance cover ear wax removal?

These are as simple as ear wax removal, and as substantial as cochlear implants. In most cases insurance will cover the cost of hearing tests. Sometimes insurance will cover treatments for hearing loss. Unfortunately, often private medical insurance does not cover hearing aids.

What does CPT code 69210 mean?

Code 69210 is defined as “removal impacted cerumen (separate procedure), one or both ears.” Use this same code only once to indicate that the procedure was performed, whether it involved removal of impacted cerumen from one or both ears.

How do you bill 69210 for both ears?

A: The coder would report CPT code 69210 (removal impacted cerumen requiring instrumentation, unilateral) with modifier -50 (bilateral procedure) twice. Alternatively, the coder could report code 69210 twice with modifiers -LT (left side) and -RT (right side).

Does Medicare pay for 69210?

Medicare payment policy doesn’t always match the American Medical Association’s Current Procedural Terminology (CPT). The bottom line is that Medicare will pay you the same amount for 69210 whether you do one ear or two, even though the CPT descriptor now says it is for one ear only.

What is the ICD 10 code for cerumen impaction?

Impacted cerumen, unspecified ear H61. 20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2020 edition of ICD-10-CM H61.

How does an ENT remove ear wax?

Your ENT can remove the earwax buildup or impacted earwax in the office. They will irrigate your ear canal with special substances made to soften and dissolve earwax. Then they will gently irrigate the ear canal to remove the earwax. It is a simple procedure, but you should not attempt it at home.

How is impacted cerumen removed from the ear?

Earwax is produced by glands in the ear canal, which leads from the outer ear to the eardrum. Impacted cerumen should be removed by a doctor to help avoid damaging the ear. Treatment options include removing the earwax with instruments or by flushing the ear canal with special liquids.

Can a nurse Bill 69210?

Some payers continue to observe this restriction, while others may allow an NPP (such as nurse practitioner, physician assistant, or clinical nurse specialist) to perform and report 69210. Inquire with your individual payers to be certain of their requirements. CPT® identifies 69210 as a unilateral procedure.

Who can perform CPT code 69209?

Nurse may perform the service: The clinical example provided by the AMA in CPT Changes: An Insider’s View makes it clear that 69209, which has no physician work relative value units attached to it, can be performed by a nurse.

What is a 50 modifier used for?

CPT Modifier 50 Bilateral Procedures – Professional Claims Only. Modifier 50 is used to report bilateral procedures that are performed during the same operative session by the same physician in either separate operative areas (e.g. hands, feet, legs, arms, ears), or one (same) operative area (e.g. nose, eyes, breasts).

Can a nurse Bill 69209?

69209 Medical Assistant. Can you bill for a 69209 (removal of cerumen using irrigation/lavage) when it is performed by a Medical Assistant? 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.

Can you code 69209 and 69210 together?

Answer: If you look at the parenthetical note with 69209 (Removal impacted cerumen using irrigation/lavage, unilateral), it says that you cannot report the code with 69210 (Removal impacted cerumen requiring instrumentation, unilateral) for the same ear.

Can a nurse remove impacted cerumen?

Does a physician have to remove cerumen to bill 69210 or 69209 or can a nurse remove it and still bill? 69209 can be done by the MA/Nurse as long as there is a cerumen impaction documented. this can be done by irrigation only.

What is earwax made of?

Earwax consists of dead skin cells, hair, and the secretions of cerumen by the ceruminous and sebaceous glands of the outer ear canal. Major components of earwax are long chain fatty acids, both saturated and unsaturated, alcohols, squalene, and cholesterol.