ICD-10 code H61.22 designates a diagnosis of impacted cerumen, left ear — a condition in which earwax has accumulated to a degree that it cannot clear through normal physiological mechanisms and is producing symptoms or obstructing clinical examination of the left ear canal. This is a billable, laterality-specific code valid for all HIPAA-covered transactions from October 1, 2024 through September 30, 2025 (FY 2025), and it carries forward unchanged into FY 2026. Per the ICD-10-CM Official Coding Guidelines, accurate laterality documentation is mandatory at the highest specificity available — making H61.22 the required code whenever impaction is confirmed exclusively in the left ear.
What Does ICD-10 Code H61.22 Mean?
H61.22 is a billable, laterality-specific diagnosis code that identifies cerumen impaction confined to the left external auditory canal. It sits within category H61.2 (Impacted cerumen), under the broader parent H61 (Other disorders of external ear), which falls in Chapter 8 of ICD-10-CM: Diseases of the Ear and Mastoid Process.
Key attributes of this code at a glance:
- Valid for use: FY 2025 and FY 2026 — no changes to description or validity status since introduction in FY 2016
- Billable/specific: Yes — can be used as a standalone diagnosis on claims
- Laterality required: Yes — left ear must be specified in the clinical record
- Questionable admission diagnosis: Yes — H61.22 is not typically sufficient justification for acute inpatient admission as a principal diagnosis
- MS-DRG assignment: Groups to MS-DRGs 154, 155, or 156 (Other ear, nose, mouth, and throat diagnoses with MCC/CC/without CC/MCC) when used in the inpatient setting
What Conditions and Diagnoses Does H61.22 Cover?
H61.22 applies when the clinical picture confirms that earwax in the left ear has become impacted — not simply present. Synonyms and clinical terms mapped to this code include:
- Left impacted cerumen
- Excessive cerumen in left ear canal
- Cerumen accumulation, left ear (with impaction confirmed)
- Occluded left external auditory canal due to cerumen
- Left ear wax buildup causing conductive hearing reduction or pain
What Does H61.22 Specifically Exclude?
H61.22 carries important Excludes2 notations inherited from the parent category, meaning these conditions are not part of the cerumen impaction code but may co-exist and be coded additionally if documented:
- Acquired stenosis of the external ear canal (H61.3x) — separate structural narrowing, not the impaction itself
- Otitis externa (H60.x) — any concomitant external ear infection is coded separately
- Hearing loss due to external ear obstruction — when documented as a separate reportable condition, it requires its own code (e.g., H91.9x), but note the Excludes1 interaction discussed in the billing section below
When Is H61.22 the Right Code to Use?
Selecting H61.22 requires more than a patient complaint of “blocked ear.” Follow this decision sequence before assigning the code:
- Confirm impaction is documented — the provider’s note must use language that clearly indicates impaction, occlusion, or that the cerumen cannot be removed without intervention. Simple “cerumen present” language does not meet this threshold.
- Confirm laterality is left — the clinical note, otoscopic exam finding, or procedure note must specify the left ear.
- Confirm impaction is the primary reason for the encounter — or that it contributes meaningfully to the documented clinical problem.
- Rule out bilateral involvement — if both ears are impacted and documented, H61.23 (bilateral) is appropriate instead.
- Rule out right-ear-only involvement — if only the right ear is impacted, H61.21 applies.
How Does H61.22 Differ From H61.21 and H61.23?
This is the most common laterality confusion in the H61.2x family. Use this table to select correctly every time:
| Code | Description | When to Use |
|---|---|---|
| H61.21 | Impacted cerumen, right ear | Documentation specifies right ear only |
| H61.22 | Impacted cerumen, left ear | Documentation specifies left ear only |
| H61.23 | Impacted cerumen, bilateral | Both ears impacted and documented as such |
| H61.20 | Impacted cerumen, unspecified ear | Only when laterality genuinely cannot be determined — avoid if possible |
In practice, coders frequently encounter provider notes that say “cerumen impaction” without specifying laterality, then document the removal procedure (e.g., irrigation of the left ear) which implicitly identifies the affected side. The procedure note is an acceptable source for laterality when the diagnosis note is incomplete — but query the provider when there is any ambiguity, particularly if both ears were examined.
What Documentation Is Required to Support H61.22?
What Must the Provider Document in the Clinical Notes?
The following elements are required to support H61.22 on a claim and withstand coding audit preparation scrutiny:
- A chief complaint or presenting problem that references the left ear (e.g., “left ear fullness,” “decreased hearing left side,” “left ear pain”)
- An otoscopic examination finding that confirms cerumen impaction in the left external auditory canal — phrases like “left EAC occluded by cerumen,” “impacted wax left ear,” or “cerumen blocking TM visualization left ear” are all sufficient
- The clinical impact of the impaction (hearing change, discomfort, tinnitus) or documentation that impaction was identified during a preventive encounter
- If a removal procedure was performed, the procedure note must specify the left ear and describe the technique (irrigation, curettage, suction)
Which Diagnostic or Lab Results Support This Code?
H61.22 is a clinical diagnosis — no laboratory tests are required. However, the following exam findings strengthen documentation and claims integrity:
- Otoscopic confirmation of left EAC occlusion or partial occlusion
- Audiometric or tuning fork findings consistent with left-sided conductive hearing reduction (if hearing loss is separately documented)
- Notation that the tympanic membrane was not visualizable due to cerumen (pre-removal)
- Post-procedure notation confirming TM visualization after cerumen removal
What Is the Documentation Standard for Inpatient vs. Outpatient Settings?
| Setting | Documentation Requirement | Sequencing Note |
|---|---|---|
| Outpatient / Office | First-listed diagnosis; document as reason for encounter | H61.22 is typically the only or principal outpatient code |
| Inpatient | Not a typical inpatient principal diagnosis; use as secondary if cerumen impaction complicates another condition | Underlying condition sequenced first |
| Telehealth / Virtual | Requires a follow-up in-person visit for the procedure; diagnosis can be established via patient history and symptoms | Same documentation rules apply |
How Does H61.22 Affect Medical Billing and Claims?
H61.22 is among the highest-frequency otolaryngology-adjacent codes billed in primary care, urgent care, and ENT settings. Payer considerations include:
- Medical necessity must be established — “cerumen present” without impaction language may trigger claim denial; “impacted cerumen” with documented symptom impact satisfies most LCD requirements
- Medicare and most commercial payers cover cerumen removal when H61.22 (or H61.2x) is the supporting diagnosis, but coverage rules vary by payer for the specific removal CPT code
- Modifier use: When a separately identifiable E/M visit is billed on the same day as cerumen removal, Modifier 25 is required on the E/M code to indicate a significant, separately identifiable evaluation and management service
What CPT or Procedure Codes Are Commonly Billed With H61.22?
| CPT Code | Description | Typical Pairing Context |
|---|---|---|
| 69210 | Removal of impacted cerumen (one or both ears), physician service | Standard cerumen removal with instrumentation; requires impaction documentation |
| 69209 | Removal of cerumen using irrigation/lavage, unilateral | Irrigation-based removal; some payers distinguish 69209 from 69210 by technique |
| 92557 | Comprehensive audiometry threshold evaluation | Ordered when hearing loss accompanies impaction |
| 99213/99214 | Office E/M visit (with Modifier 25) | When a separate, medically necessary E/M is documented on the same date as removal |
Billing alert: CPT 69210 has historically been a frequent target for payer downcoding or non-coverage when the supporting diagnosis does not include explicit impaction language. H61.22 — rather than a non-impaction ear code — is the correct diagnosis that unlocks reimbursement for 69210 under most LCDs.
Are There Any Prior Authorization or Coverage Restrictions?
- Most Medicare Administrative Contractors (MACs) do not require prior authorization for cerumen removal under H61.22, but local coverage determinations (LCDs) may apply
- Some commercial plans require that the procedure be performed by a physician, not an audiologist or MA — verify with the specific plan
- Bilateral removal (H61.23 with 69210 billed bilaterally) may prompt additional documentation review at some payers
- H91.90 (unspecified hearing loss) interaction: An Excludes1 note applies — do not report H91.90 on the same claim line as 69210 if the hearing loss is solely due to the cerumen impaction; the impaction code itself captures the obstruction-related hearing impact
What Coding Errors Should You Avoid With H61.22?
These are the most frequently cited errors when H61.22 is audited or denied:
- Using H61.20 (unspecified ear) when laterality is documented — laterality must be coded to the highest specificity; using the unspecified code when the record clearly identifies the left ear is a coding error under ICD-10-CM Official Coding Guidelines specificity rules
- Coding H61.22 from documentation that says “cerumen” without “impacted” — regular cerumen without impaction does not meet the definition; use H61.89x (other specified disorders of external ear) or query the provider
- Omitting Modifier 25 when billing E/M with 69210 — without Modifier 25, the E/M is bundled into the procedure payment and the practice loses rightful reimbursement
- Billing 69209 and 69210 together for the same ear on the same date — these are mutually exclusive; select the one that reflects the technique documented
- Upcoding to H61.23 (bilateral) without bilateral documentation — if only one ear is treated and documented, H61.23 is not appropriate even if the other ear was examined and found clear
What Do Auditors Look for When Reviewing Claims With H61.22?
- Mismatch between the procedure note laterality and the ICD-10 code laterality (e.g., right ear procedure with H61.22 — left ear — assigned)
- Absence of otoscopic exam findings in the clinical note
- Missing Modifier 25 on a same-day E/M
- Diagnosis code H61.22 applied to a claim for 69209 when documentation describes cerumen removal without explicit impaction language
- Bilateral procedure billed with a unilateral diagnosis code (or vice versa)
How Does H61.22 Relate to Other ICD-10 Codes?
| Code | Relationship | Key Distinction |
|---|---|---|
| H61.21 | Same category, right ear | Laterality is right, not left |
| H61.23 | Same category, bilateral | Both ears impacted and documented |
| H61.20 | Same category, unspecified | Use only when laterality truly cannot be determined |
| H60.50x | Acute otitis externa, unspecified | Separate condition; can co-exist with H61.22 (Excludes2) |
| H91.90 | Hearing loss, unspecified | Excludes1 interaction when coded with 69210 — do not co-report if hearing loss is due solely to impaction |
| H61.89x | Other specified disorders of external ear | Use when cerumen is present but not impacted |
What Is the Correct Code Sequencing When H61.22 Appears With Other Diagnoses?
- In the outpatient setting, sequence H61.22 first if cerumen impaction is the primary reason for the encounter.
- If an otitis externa (H60.x) is also present and documented, sequence based on the condition chiefly responsible for the encounter — do not default to alphabetical order.
- If hearing loss is separately documented and attributable to a cause other than the impaction (e.g., sensorineural loss), it may be coded additionally with an appropriate H90.x code — but confirm this is clinically distinct from the obstruction-related component before adding it.
- In the inpatient setting, code the principal diagnosis (the condition established after study to be chiefly responsible for the admission) first; H61.22 is typically a secondary code in inpatient encounters.
Real-World Coding Scenario — How H61.22 Is Applied in Practice
Encounter summary: A 58-year-old patient presents to a family practice office with a three-day history of decreased hearing and fullness in the left ear. The physician documents: “Otoscopic exam: Left EAC completely occluded by dark brown impacted cerumen; TM not visualizable. Right ear: clear, TM intact. Performed manual curettage of left ear under otoscopic guidance; cerumen removed successfully; post-procedure TM visualized, intact.” A brief E/M is also documented addressing a separate blood pressure management concern.
Correct Code Application
- H61.22 — Impacted cerumen, left ear (confirmed by otoscopic exam, laterality explicit)
- 69210 — Removal of impacted cerumen by instrumentation (manual curettage documented)
- 99213-25 — Office E/M with Modifier 25 for the separately documented blood pressure management concern
Common Mistake in This Scenario
- Incorrect: Assigning H61.20 (unspecified) because the coder did not read the exam note carefully
- Incorrect: Billing 69210 without H61.22 and instead using a symptom code — payers require the impaction code to trigger coverage of the procedure
- Incorrect: Omitting Modifier 25 on the E/M, resulting in the E/M being bundled into the 69210 payment and lost reimbursement
Frequently Asked Questions About ICD-10 Code H61.22
Is ICD-10 Code H61.22 Valid for Use in 2025 and 2026?
H61.22 is a valid, billable ICD-10-CM code for both FY 2025 (October 1, 2024 – September 30, 2025) and FY 2026 (October 1, 2025 – September 30, 2026), with no changes to its description or validity since it was introduced as a new code in FY 2016. Coders should verify annually against the ICD-10-CM Official Coding Guidelines update published by CMS to confirm continued validity.
What Is the Difference Between H61.22 and H61.23?
H61.22 designates impaction confined exclusively to the left ear, while H61.23 is used when both ears are impacted and that bilateral involvement is explicitly documented. Assigning H61.23 based on a unilateral procedure note or an assumption about the other ear without documentation is a coding error and an audit risk.
Can H61.22 Be Used to Support CPT 69210 for Reimbursement?
H61.22 is the preferred supporting diagnosis for CPT 69210 (removal of impacted cerumen by instrumentation) when the left ear is the affected side. Most payers and MAC LCDs require an impaction-specific code from the H61.2x family to adjudicate 69210 as medically necessary — a non-impaction external ear code will not satisfy coverage criteria.
What Should I Code if the Provider Documents “Cerumen” but Not “Impacted Cerumen” for the Left Ear?
If documentation describes cerumen in the left ear without explicitly characterizing it as impacted, H61.22 should not be assigned. The appropriate course is to query the provider for clarification; if cerumen is present but not impacted, H61.89x (other specified disorders of external ear) or a symptom code reflecting the patient’s complaint may be more appropriate, depending on the encounter context.
Can H91.90 (Hearing Loss) Be Coded Alongside H61.22?
H91.90 should not be reported on the same claim line as CPT 69210 when the hearing loss is caused by the cerumen impaction — an Excludes1 note interaction makes this pairing on the procedure line inappropriate. However, if the patient has a documented, separate sensorineural or other hearing loss that is clinically distinct from the obstruction caused by the impaction, a different hearing loss code (such as H90.x) may be reported separately and placed on a different claim line.
Does H61.22 Require Modifier 25 When an E/M Is Billed on the Same Day?
H61.22 itself does not require Modifier 25 — the modifier is applied to the E/M procedure code (e.g., 99213-25) when a significant, separately identifiable evaluation and management service is provided on the same date as the cerumen removal procedure. Without Modifier 25, payers will bundle the E/M into the procedure reimbursement. The E/M must be documented as addressing a separate medical issue or a more extensive evaluation than what is inherent to the removal procedure itself.
Key Takeaways
Every coder and biller working with H61.22 should keep these points in hand:
- H61.22 is valid and billable for FY 2025–2026 with no recent code changes
- Laterality specificity is mandatory — left ear must be explicitly confirmed in the clinical record before assigning this code over H61.20 (unspecified)
- The distinction between “cerumen present” and “impacted cerumen” is a coverage and audit threshold — only impaction language supports H61.22 and unlocks reimbursement for CPT 69210
- Modifier 25 must be appended to any same-date E/M to prevent bundling into the procedure payment
- H61.23 (bilateral) is appropriate only when both ears are documented as impacted — do not upcode from H61.22 based on assumptions
- Auditors specifically look for laterality mismatches between the ICD-10 code and the procedure note
- When hearing loss is documented as a separate, clinically distinct condition, select the appropriate H90.x code rather than H91.90 to avoid the Excludes1 conflict with procedure billing
For authoritative guidance, consult the CMS ICD-10-CM code lookup and tabular list, the WHO ICD reference, and — for procedure-level billing guidance on 69210 and 69209 — the AAPC coding resources and AHA Coding Clinic advisories.