What is the CPT (Current Procedural Terminology) code and billing amount for irrigation to remove a foreign object from the ear?

CPT Coding for Foreign Body Removal from Ear by Irrigation

The CPT code for irrigation to remove a foreign object from the ear is 69209, which is billed at approximately $50-75 depending on your location and payer contracts.

CPT Code Details

• 69209: Removal of impacted cerumen using irrigation/lavage, unilateral
• This code applies specifically to the removal of foreign bodies or impacted cerumen via irrigation technique

Billing Considerations

• The procedure must be performed by a healthcare provider (physician, nurse practitioner, or physician assistant)
• Documentation should include:
  • Visualization of the ear canal before and after the procedure
  • Confirmation of the foreign body presence
  • Method used for removal (irrigation)
  • Resolution of the impaction or foreign body

Clinical Considerations When Using Irrigation

Contraindications

Irrigation should be avoided in patients with:

• History of tympanic membrane perforation 1, 2
• Previous ear surgery 1, 2
• Patent pressure-equalizing tubes 1
• Anatomical abnormalities of the ear canal 1, 2
• Inability to visualize the tympanic membrane (unless history confirms intact membrane) 2

Special Patient Populations

• Diabetic patients: Use caution due to higher risk of malignant otitis externa; avoid tap water and instruct patients to report otorrhea or otalgia promptly 1, 2
• Elderly patients: May have more fragile ear canals and higher risk of complications 2
• Children: May require additional restraint and have smaller ear canals 2

Technique Tips

• Use cerumenolytic agents 15 minutes before irrigation to soften wax and reduce water volume needed 2
• Water should be at body temperature to prevent caloric effects and vertigo 2
• Direct water stream at the canal wall, NOT directly at the tympanic membrane 2
• Consider reacidifying the ear canal with vinegar or acetic acid drops after the procedure 1, 2

Alternative CPT Codes

If irrigation is not used and manual instrumentation is required instead:

• 69210: Removal of impacted cerumen requiring instrumentation, unilateral

Success Rates and Complications

• Success rates for foreign body removal using irrigation range from 88-93% 3
• Complication rates are approximately 1 in 1000 irrigations 2
• Multiple attempts at removal are associated with higher failure rates (RR 6.0) and complications (RR 3.1) 4
• Use of multiple instruments is associated with higher failure rates (RR 5.4) and complications (RR 4.0) 4

Billing Pitfalls to Avoid

• Do not bill for both 69209 and 69210 for the same ear on the same day
• Ensure documentation supports medical necessity for the procedure
• Do not bill if irrigation is performed as part of a routine office visit without specific medical necessity
• If bilateral irrigation is performed, use modifier -50 (bilateral procedure)