Otolaryngology Coding Alert

The H61.2- family will have all your code choices.

Impacted cerumen can be a fairly common diagnosis for an otolaryngologist to report. Because of this, be sure your providers start thinking now about important details they’ll need to include in their documentation once ICD-10 becomes effective in October 2014.

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Prepare for Right/Left Specifications

ICD-9 currently provides a single diagnosis code for impacted cerumen: 380.4 (Impacted cerumen). Coding guidelines instruct you to report an additional external cause code, if applicable, to identify the cause of the ear condition.

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“Typically, when ICD-9 refers to an ‘external cause code,’ it’s referring to an E code,” says Kent J. Moore, manager of healthcare delivery and finance systems for the American Academy of Family Practice (AAFP) in Leawood, Kan. “In general, most external cause codes aren’t applicable to impacted cerumen. The only one that might be applicable is E013.8 (Activities involving personal hygiene and household maintenance; other personal hygiene activity).”

“If the impacted cerumen was the result of someone trying to clean his or her ear out with a Q-tip, you might be able to list E013.8 as an external cause,” Moore adds.

“That said, most times an external cause code won’t be needed or applicable.”

ICD-10 change: Documentation and your resulting diagnosis coding will need to be more specific under ICD-10. You’ll find your choices in the H61.2- (Impacted cerumen) series of codes. The fourth digit will specify the affected ear:

• H61.20, Impacted cerumen, unspecified ear
• H61.21, Impacted cerumen, right ear
• H61.22, Impacted cerumen, left ear
• H61.23, Impacted cerumen, bilateral.

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The procedure: Physicians typically diagnose impacted cerumen by examining the patient’s ear canal and eardrum with an otoscope. Irrigation is the most common method of removing impacted cerumen; the process involves washing out the ear canal with water from a commercial irrigator or a syringe with a catheter attached. A primary care physician normally uses irrigation to treat impacted cerumen (although ear irrigation to remove impacted cerumen does not qualify for coding separate from an E/M service).

If irrigation is not an option or if it fails to remove the cerumen, the primary care physician could refer the patient to an otolaryngologist. The otolaryngologist can remove the wax with a vacuum device or curette (a small, scoop-shaped instrument). The physician uses the curette to ease the impacted wax away from the sides of the ear canal. This ear wax removed by the physician using instrumentation and direct visualization is consistent with CPT® code 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) for the procedure. This code cannot be used for irrigation only and will have a different definition for 2014. The change makes a large difference in the coding and potentially will effect reimbursement. Beginning Jan. 1, 2014, 69210 will be defined as: Removal impacted cerumen (separate procedure) requiring instrumentation, 1 or both ears unilateral.

Future coding: Physicians will need to be more detailed in their documentation of impacted cerumen by noting which ear is affected and how they treated the problem. Let your physicians know that they need to include details regarding which ear has impacted cerumen, so you don’t have to report the “unspecified” diagnosis. Many payers have said that they will not process claims which indicate ICD-10-CM codes that are “unspecified” since there is no reason for this information to be available for coding more accurately.

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