To determine whether a case involves 380.4 (Impacted cerumen) and hence is eligible for 69210 (Removal impacted cerumen [separate procedure], one or both ears), use the following clinical guidelines. "In 2005, CPT gave its seal of approval to the American Academy of Otolaryngology -- Head and Neck Surgery's (AAO-HNS) definition" of impacted cerumen, says Marie West, CCS-P, CMSCS, CCP, in Oklahoma City. You should consider cerumen "impacted" if any one or more of the following considerations are present: 1. Visual considerations: Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition.
2. Qualitative considerations: Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc.
3. Inflammatory considerations: Associated with foul odor, infection or dermatitis.
4. Quantitative considerations: Obstructive, copious cerumen that cannot be removed without magnification and multiple instrumentations requiring physician skills.