CPT gives lavage/irrigation its own code.
Coding for cerumen (earwax) removal is going to get a whole lot easier in 2016.
Reason: CPT® is introducing 69209 (Removal impacted cerumen using irrigation/lavage, unilateral). This code will allow you to code for encounters when your provider removes impacted cerumen using irrigation or lavage. Previous coding guidelines have always stated that you must have documentation of the cerumen being impacted before you could submit a cerumen removal code – typically 69210 (Removal impacted cerumen requiring instrumentation, unilateral).
If the cerumen wasn’t impacted or if the physician didn’t use any type of instrumentation during the removal, you couldn’t choose a procedure code for the service; it was included in a typical E/M code such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components …).
CPT® 2016 will change that with new code 69209.
Lavage and irrigation “is basically what primary care doctors do to remove cerumen,” explains Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CENTC, CPCO, vice president of the coding and consulting division of J. & S. Stark Billing & Consulting, Inc., in Shrewsbury, N.J.
Important: Physicians will have to demonstrate that their E/M is a significant and separately identifiable service (represented by modifier 25) in order to bill an E/M and the new code 69209 if it is not status B (bundled) in the payer’s fee schedule.
Payers have not yet determined the status of 69209.
“Once the insurers release their fee schedules, it will be important to determine whether 69209 has a status of B, meaning that it’s bundled with the E/M and therefore cannot be reported separately,” says Cobuzzi. Physicians will have to “demonstrate that their E/M is significant and separately identifiable (25 modified) in order to bill an E/M and the new code 69209 if it is not status B,” she advises. Check the Medicare Physician Fee Schedule for the latest on reimbursement and status of any procedure.