five precautions to cerumen management
read license laws
determine if there are restrictions in work place
follow CDC's precautions
obtain informed consent
develop plan for medical emergencies
name three methods to cerumen removal
mechanical removal with instruments, suction, and irrigation with water
when irrigation is indicated
more complete occlusions with hardened/dry wax
importance of coding (5)
to document procedures that were carried out (CPT)
to reflect diagnosis and findings (ICD 10)
to code hearing devices with HCPCS codes
show continuity of care, what has been done, and next steps
required for reimbursement
HCPCS
based on CPT codes to promote common language
4 risks for cerumen removal
scraping canal walls
perforate TM
make chronic ME disorder worse
damage ossicular chain
mechanical removal with instruments
most common
for partially occluded canal, when wax is not adhered to skin
requires using sterilized instruments to remove cerumen
when to mechanically remove wax
partially occluded canal and wax is not adhered to skin
CPT defined
current procedural terminology codes
- document procedures to describe medical, surgical, diagnostic, and rehab procedures
HCPCS facts
different levels of codes
audiologists mainly use level II for durable medical equipment (DME) (aka hearing devices)
name 7 contraindications to cerumen removal
ear pain
drainage
ear surgery
dizziness
diabetes (irrigation)
AIDS
anything else that puts pt at risk (large ECV, CHL, MHL, ME dysfunction)
irrigation (water)
water gently introduced in canal
don't direct stream at ear drum
point toward canal wall w/ least amount of wax
often drape pt with towel and have them hold basin
use irrigation with more complete occlusions and when wax is hardened
two methods that are not recommended for cerumen removal
cotton swabs and ear candling
CPT info
belong to American Medical Association
5 digits
updated often
92557
basic comprehensive audiometry (AC, BC, SRT, WRS)
cerumenolytic
four types of instruments to remove wax
curettes, wire loops, alligator forceps, specula tip for otoscopy
92553
pure tone audiometry, air and bone
ICD 10 defined
diagnoses and descriptions of what was found as a result of CPT codes
92551
screening, pure tone, air only
2 examples of cerumenolytics
audiologists choice, debrox, murine ear wax removal system
summarize potential threat to hearing posed by removing cerumen via suction
suction equipment may produce loud sounds next to ear and pose a threat to create NIHL, tinnitus, or both
92555
speech audiometry threshold
ICD 10 facts
owned by WHO
must be justifiable and supported by documentation
allows health data to be tracked, standard tool for clinical purposes
audiologists have been using these since 80s
required for reimbursement
letters and numbers
most start with H for no reason
92552
pure tone audiometry, air only