Cerumen Removal (CPT code 69210)

This page is extracted from a column by David Stern, MD, CPC in the Journal of Urgent Care Medicine, February 2007

In our urgent care center, we frequently remove impacted cerumen from the ears. We use different methods for removing the cerumen, including irrigation, spoon, loop, or forceps. When can I use CPT code 69210, “Removal impacted cerumen (separate procedure), one or both ears”?

CMS limits payment for CPT code 69210 to ear wax removal during visits that meet all of the following criteria:

• Cerumen removal is the only reason for the visit.
• Cerumen removal is performed personally by a physician or midlevel provider.
• The patient is symptomatic (pain, pressure, poor hearing, etc.) from excessive cerumen.
• Cerumen removal requires more than drops, cotton swabs, and cerumen spoon.
• Documentation in the patient record shows that the procedure required significant time and effort.

The CPT definition for this code (69210) does not specify the method used by the physician for cerumen removal, and many payors use different guidelines for coding for cerumen removal. Urgent care centers should check with individual payors to determine their policies for using this code.

Note: This information is for coding educational purposes only and should not be used as a clinical guide or as a guide for any specific coding scenario. The user of this information specifically releases Practice Velocity, LLC from any liability or potential liability that might arise as a direct or indirect consequence from reading the information contained on this website.

Some of this information may be expanded from the Coding Q&A column by David Stern, MD, CPC (CEO, Practice Velocity, LLC) published monthly in the Journal of Urgent Care Medicine. Physicians may click on the JUCM icon to the left to order a FREE SUBSCRIPTION to the Journal.

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