How often do you get denied for CPT code 69210? You might not be following the required billing guidelines. If we talk about the exact numbers, around 8 million cerumen removal procedures are performed in the U.S. each year. Hence, removing earwax blockage is almost a routine for many Ear, Nose, and Throat (ENT) specialists.
However, they often find themselves in financial distress due to inaccurate billing. The most common reasons? Coding confusion and incomplete documentation! CPT 69210 is a pretty straightforward code, yet even the most experienced professionals struggle with its requirements.
We are here to help you understand this cerumen impaction removal code. So, read on to discover the best billing and reimbursement tips for CPT code 69210.
CPT Code 69210 – Description
To understand the billing requirements, you must first know what CPT code 69210 refers to. Categorized under external ear removal procedures, 69210 highlights the instrumented approach for removing entrapped wax, medically known as cerumen impaction.
Don’t understand the complicated language? Let us simplify it for you! This code refers to the manual removal of earwax blockage. During this procedure, healthcare providers use an instrument, like a curette, forceps, or vacuum, to clear excessive wax buildup from a patient’s ear.
This earwax is often firmly lodged in the ear canal and cannot be easily removed with simple irrigation. Most importantly, it is the root cause of various ear issues, including pain, dizziness, irritation, and even hearing loss. Hence, ENT specialists take a hands-on approach to address this problem.
Scenarios Where CPT Code 69210 is Applicable
Now, let’s look at three applicable scenarios for CPT code 69210:
Removal of Impacted Cerumen from a Child’s Ear
Anyone can have excessive earwax buildup, but this issue is more common among children than adults. Specifically, about 10% of children have impacted cerumen during routine examinations. Therefore, let’s use this as our first example.
Suppose an 8-year-old child experiences increasing itchiness and pain in her left ear. Distressed by her symptoms and complaints about muffled hearing in the classroom, her parents take her to an otolaryngologist. Upon examination, the physician identifies hardened, dark wax in the patient’s ear canal.
After discussing the situation with her parents, he manually removes the buildup with a curette. He then uses CPT code 69210 to bill for the procedure.
Removing Earwax Blockage in a Teen with Eczema
Did you know that individuals with eczema are also at a higher risk of developing increased earwax buildup? Since this skin condition is more common among people who are under 17, let’s envision this scenario:
Consider a 15-year-old with atopic dermatitis (eczema). He visits an ENT specialist on his dermatologist’s recommendation after experiencing itchiness and fullness in his right ear. After examining his ear, the specialist identifies the problem: thicker and drier flaky earwax buildup.
Since irrigation is not ideal, the healthcare provider uses a curette to remove the blockage. He then files a claim for the procedure using CPT code 69210.
Removing Earwax Blockage for Hearing Test
Ear cleaning is crucial before hearing tests, helping audiologists get a clearer view of your inner ear. But what if you have an earwax blockage? For our final example, suppose a 65-year-old man with partial hearing loss appears for a routine test.
Due to his busy schedule, he refers the patient to an otolaryngologist for ear cleaning and reschedules the test. The patient then visits the ENT specialist clinic for cerumen removal, where the specialist cleans his ear using a curette. The otolaryngologist then bills for the procedure using CPT code 69210.
Applicable Modifiers for CPT Code 69210
Want to provide more details about the earwax removal procedure to payers? You can use the following modifiers with CPT code 69210:
Modifier LT
You must specify the ear from which you removed the wax. If you performed a manual wax blockage removal procedure on the left ear, append modifier LT to CPT code 69210.
Modifier RT
If you took an instrumented approach to clear the right ear’s impacted cerumen, apply modifier RT to CPT code 69210.
Modifier 59
If the earwax blockage removal procedure was distinct from another service you performed on the same date of service on the same patient, you can use modifier 59 with CPT code 69210. This modifier helps you report a service/procedure that does not usually receive separate payment from the first procedure.
However, our advice is to be more specific. Therefore, use X{EPSU} modifiers instead of modifier 59 if they are applicable.
Modifier GA
Was the earwax removal not medically necessary? Use modifier GA with CPT code 69210 if you anticipate a denial from Medicare. Modifier GA indicates that you issued an Advanced Beneficiary Notice (ABN) to the patient before providing the service, and the patient, in turn, knows about the coverage limitation.
CPT Code 69210 – Billing & Reimbursement Guidelines
Was your claim for code 69210 denied due to lack of medical necessity or any other reason? Here is how you can bill it accurately:
Use 69210 to Report the Instrumented Approach
According to the official description, CPT code 69210 only covers the instrumented technique for removing impacted cerumen. In simple terms? Using forceps, a curette, or vacuum suction to clear earwax buildup! Hence, avoid using this code if you have used another earwax removal method, such as irrigation, to clean the ear canal.
Document the Medical Necessity
The earwax blockage removal must be medically necessary. Simply put, you have to make sure that the excessive buildup in the ear canal is causing problems before using an instrument to remove it. Don’t forget to document the medical necessity before filing any claim for CPT code 69210. You can do that by recording the following details:
- Patient symptoms
- Assessment results
- Relevant medical history
- Operative report (used instrument, potential hiccups, time, and effort)
Apply Appropriate Modifiers
Don’t leave a single gap in your billing. Use laterality modifiers with CPT code 69210 to specify which ear you removed the impacted cerumen from. This will help you avoid payment delays or, in extreme cases, denials.
Pay Attention to Payer-Specific Requirements
The biggest mistake most providers and even billing professionals make is overlooking specific payer requirements. You can only avoid denials if you know each insurance payer’s coverage limitations.
For instance, Medicare does not accept CPT code 69210 with modifier 50. Moreover, it only covers the removal procedure if the cerumen is impacted (hardened earwax blocking the ear canal and causing issues).
Want to know another important detail? Medicare only considers earwax blockage removal procedures performed by physicians. Hence, an audiologist cannot bill for CPT code 69210.
Summary
Stop giving payers a chance to deny your claims with inaccurate coding. Although we covered CPT code 69210 in detail, let’s do a quick recap in case you skimmed most of the information.
CPT 69210 specifies the removal of entrapped earwax using a special instrument, such as a curette, forceps, or vacuum suction.
Most insurance payers, including Medicare, only cover this procedure if it is medically necessary. Hence, documentation is mandatory! We highlighted three specific scenarios and the required modifiers to help you file accurate claims.
