CPT Code for Ear Flush (Irrigation)
The CPT code for ear irrigation/flush is 69209 for removal of impacted cerumen using irrigation/lavage, unilateral, or 69210 for bilateral.
Understanding the Procedure Codes
- CPT 69209 is used when performing ear irrigation on one ear to remove impacted cerumen 1
- CPT 69210 is used when performing bilateral ear irrigation for cerumen removal 1
- These codes specifically apply to impacted cerumen that requires mechanical removal, not routine ear cleaning 1
Key Documentation Requirements for Billing
To properly bill for ear irrigation, you must document:
- Evidence of impaction: The cerumen must be obstructing visualization of the tympanic membrane or causing symptoms (hearing loss, pain, fullness) 2, 3
- Medical necessity: Document the percentage of tympanic membrane obscured (typically ≥50% obstruction) 3
- Failed conservative management: Note if cerumenolytic drops were attempted first or why they were not appropriate 2, 4
- Procedure details: Number of irrigation attempts, volume used, and post-procedure visualization of the tympanic membrane 3
Clinical Context for Proper Code Use
Do not use these codes for:
- Routine ear cleaning without impaction 4
- Intraoperative saline washout during tympanostomy tube placement (this is included in the tube insertion code) 1
- Simple removal of non-impacted wax that migrates naturally 5
Appropriate use includes:
- Symptomatic impacted cerumen causing hearing loss, pain, or complete canal obstruction 2, 3
- Failed self-cleaning mechanism requiring intervention 5, 4
- Cerumen preventing adequate otoscopic examination when medically necessary 3
Common Billing Pitfalls
- Insufficient documentation of impaction severity can lead to claim denials 6
- Failing to document that conservative measures were considered (cerumenolytic drops for 5 days are evidence-based first-line treatment) 2, 4
- Using irrigation codes when manual removal with curette or forceps was the primary method (different CPT codes apply) 3, 4
- Not documenting contraindications to irrigation if present (perforated tympanic membrane, previous ear surgery, acute otitis externa) 7, 4