How to code for Cerumen Removal and its Dx code for medical coding

What is Cerumen Removal in medical coding?

I’ll explain what cerumen is to you. Cerumen is earwax, so you’d think that coding for it would be straightforward. Surprisingly, though, there is still a lot of misinformation about how to code for cerumen first things. If it’s only a standard ear cleaning, we must first confirm that the paperwork shows that the cerumen is affected. Really, there is no medical need for a doctor to do it.

Most insurance policies don’t pay for it. There isn’t really a rule against using a q-tip to clean out your ear, despite the fact that this is technically against the rules since you shouldn’t put anything smaller than your elbow into your ear.


What the medical coding assistance manual says

In fact, a CPT assistant post from October 2013 explains what we would consider affected cerumen from a coding standpoint. It appears on page 14 of October 2013.

The cerumen interferes with the examination of clinically relevant areas of the external auditory canal, the tympanic membrane, or middle ear conditions due to visual or qualitative concerns, according to the statement. It’s incredibly dry, hard, irritating, and generates symptoms like

  1. Discomfort
  2. Itching
  3. Hearing loss
  4. Inflammation-related issues.

What is obstructive profuse cerumen?

There is obstructive profuse cerumen that cannot be removed without magnification and many tools requiring medical competence, and it is related to bowel odor infection, dermatitis, or quantitative concerns. The h61.2 part will now include the diagnostic codes, and this will depend.

Does the paperwork make clear which ear it was and which side was right? Was it bilateral or left-handed, and once again, this needs to be included in the paperwork in order to utilize the affected cerumen codes? While there aren’t any exclusions notes unique to these various codes, it sort of makes sense that you wouldn’t code for the accompanying signs and symptoms of that affected seromon or that the patient didn’t have permanent hearing loss. When in fact their impacted ear with cerumen was the only reason for their temporary hearing loss. Not only cannot we utilize those diagnostic codes, but also the cpt codes if there is no evidence that the cerumen has been damaged.

Chance of resembling office visits

As impacted serum will be included in that e m service, any services linked to that serum and the unaffected cerumen are not reported. They may be for that day, so many of them will likely resemble office visits. Therefore, we cannot get addenda stating that it was affected if the supplier does not prove that it was. It was affected, and these codes should be used.

The rules governing the regulations for removal of affected serum include all of it in their assessment and management service for that day.

It states that if it is not impacted, you should use the appropriate emergency medical code we have, which is when we are performing lavage, we are merely performing irrigation.

Often, they will tilt the patient’s head to the side and flush it out with water; there is typically something resembling a cup there so that any cerumen that falls out can be caught in the cup with all the extra water. Then, 69210 is used when the provider documents that they used some kind of instrumentation Therefore, they used a curette, cerumen spoon, or forceps. That affected cerumen was removed using some kind of equipment that has been described. Geo268 is another option to think about.

Although other Cerrone removals aren’t often performed in primary care settings, this code is for Medicare patients who are undergoing an audiological test and are too incapacitated to do it.

Importance of audiological test

In order to do the audiological test, they must thus remove the affected ceremony; otherwise, you cannot charge Medicare patients for the service. Now, if the patient is going in for a regular hearing test and the doctor says, “Oh, let’s clean out your ear before we conduct the hearing test,” that is OK. The fact that just one of those cpt codes for instrumentation or lavage may be invoiced on the same day of service for the same year is not covered by insurance.

Let’s assume that the provider tries to do a lavage. They go because they are unable to finish. We can’t create both of them for that year, so let’s get started on the instrumentation we’re going to develop only for the instrumentation. Both codes are unilateral on the same day, so consider your RT and LT modifiers if you’re performing the procedure on the right ear or the left ear.

If you’re performing the procedure bilaterally, Medicare will not reimburse you at that 150 percent, despite the fact that you may have split the procedure into two lines. However, now that I’ve stated it and made it public, I’m sure someone will post a comment claiming that they billed it in this manner and that’s how Medicare paid for the unit of two on the cerumen removal.

Modifier 52 for discontinued procedures

Regarding modifiers, we also need to take into account our modifier 52 for discontinued procedures. For example, if we’re using instrumentation to remove cerumen and the patient is in a lot of pain, we may decide to stop the procedure and send them home with some ear drops to try and help soften some of the impacted wax because it is so dried out and hardened. We can still charge that, but we won’t get to finish the full operation because of the 52 modifiers indicating that it was terminated.

Can a cerumen removal be done by a medical assistant and a registered nurse?

Before we discuss cerumen and office visits on the same day, our modification 25 is about a question I often hear. Many people ask: What about auxiliary personnel? Can a cerumen removal be done by a medical assistant and a registered nurse? Technically speaking, according to Medicare, this may be done by ancillary or auxiliary personnel in addition to building incidents, but you also need to take the scope of practice into account. Is that support personnel like a medical assistant qualified to do that operation and is it within their scope of practice in that state? I’ve previously worked in certain offices where, well, are medical assistants okay?

The risk of their contacting patients’ ears is too great, especially if cerumen removal and an e-m treatment are being provided on the same day. so that I may charge for both of them. What does Modifier 25 state, and do we have to satisfy our criterion for it? The process must be a major, individually recognizable one that is completed on the same day as an assessment and management service.

So if a patient comes in and complains that they can’t hear out of one ear, you can see that it is impacted with cerumen, and we remove all of that cerumen before the patient leaves. Everything was connected to that main issue, and the process used to address it fixed the presenting issue as well. The ama supports this in CPT assistance.

Real-time case study of Cerumen Removal in medical coding

It is a set of official code rules from 2016, and Pages 7–8 of the 2016 edition, issue 26, number 1 are relevant. According to the report, a 69-year-old man complains of recent hearing loss in his left ear. throughout a number of days. His external auditory canal is completely filled with cerumen impaction, it is discovered.

When a doctor uses instruments and magnification to physically remove cerumen from the canal, only the cerumen removal is invoiced and recorded due to the licensing of the CPT assistant.

I am unable to provide you with the link. You need to pay for it yourself. I do not have the rights to it, thus I am unable to provide you a copy. But CMS, which I can link to in the explanation, also supports this.

Accordingly, it states that emergency medical care provided on the same day as affected cerumen removal may not be invoiced unless it reflects and can be shown to be a major, independently identifiable service provided on the same day. Here are some of the examples that they provide.

The patient’s discomfort in the external ear is their sole complaint, and after the cerumen is removed and the patient’s pain is relieved, we just charge for the cerumen removal.

However, if the patient has had all of the affected cerumen removed and still has otitis media, an infection, or they are still unable to hear out of that ear, we will need to do some extra testing. Some further investigation and questioning are needed.


We may need to act, at which point we get that distinct e m. You won’t do anything intrusive on a patient without at least performing an examination of the region in question, therefore every treatment will have an integrated assessment and management component.

The repayment may include questions about their allergies or medical history from nearby establishments. Every operation will have some kind of assessment and management done in relation to how well it is doing. That’s all, then.

These are all the recommendations I have for accurately categorizing cerumen removals and receiving payment for them.

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