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New ear wax guidelines offer blueprint for treatment, monitoring and education

Updated guidance: What happens when an attempt at ear wax removal doesn't clear any wax? Should you report 69209 or 69210? Find out here.
Listen closely -- new clinical guidelines call for prompt intervention when providers encounter impacted cerumen and ongoing patient education about ear hygiene, among other recommendations.
The updated clinical practice guidelines, published in Otolaryngology - Head and Neck Surgery, mark the first new guidance on ear-wax treatment and removal since 2008.
"The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management," states the guidance.
Of course, on the coding side, providers found a new way to report the treatment of impacted cerumen using lavage or water treatment -- reflected in CPT code 69209, which debuted in 2016.
The main thrust of the updated guidelines is that providers should not ignore cerumen impaction. The guidelines make a strong recommendation "that clinicians should treat, or refer to a clinician who can treat, cerumen impaction, defined as an accumulation of cerumen that is associated with symptoms, prevents needed assessment of the ear or both."
The updated clinical guidelines would apply when practices report 69209 or higher-level cerumen-removal code 69210, which requires instrumentation to clear the ear canal.
The guidelines also recommend:
  • Educating patients about "proper ear hygiene to prevent cerumen impaction."
  • Confirming a cerumen impaction diagnosis when symptoms are present.
  • Assessing for factors that might modify the management of ear hygiene, such as certain medications.
  • Not treating patients who are asymptomatic and whose ears can be examined.
  • Identifying patients, such as young children, who may have impaction and who do not express symptoms.
  • When facing unsuccessful treatment, "clinicians should refer patients with persistent cerumen impaction to clinicians who have specialized equipment and training to clean and evaluate ear canals and tympanic membranes."
The updated guidelines were created by the American Academy of Otolaryngology - Head and Neck Surgery and endorsed by multiple physician associations, including the American Academy of Family Physicians and the American Academy of Pediatrics.
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