Charging for earwax removal at a well child visit?

Billing question about whether a provider can bill me separately for earwax removal at a well child visit.

Took my son for his 18mo checkup and mentioned that he seems to have a lot of earwax. He has history of ear infections, so wanted to make sure all was okay. The earwax not seem to bother him at all or cause pain. Pediatrician looked in his ears and could see the eardrum and said it looked fine, he just has more wax than other toddlers. But she offered to remove some of it if I wanted her to, otherwise I could just use some Debrox on him at home. Since we were there, I said sure and she used a curette to remove some wax in both ears. I received my bill and they are charging me $120 for the earwax removal, but I thought it would have been included in his well child visit charges which are usually covered 100% by my insurance as preventative care. After some digging on the diagnosis code she used, I found out that she diagnosed him as having "impacted" earwax (H61.20). Per billing guidelines, impacted earwax CAN be billed separately from an E/M visit, but non-impacted should not be and should be included with the E/M visit. However, the definition of impacted earwax does not match up at all with her physician notes for his well visit and what she told me verbally during our office visit. To be defined as impacted, it has to meet one or more of the following criteria:

• cerumen impairs the examination of clinically significant portions of the external auditory canal, tympanic membrane (unable to see the entire tympanic membrane), or middle ear condition;
• extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc.;
• cerumen is associated with foul odor, infection, or dermatitis; or
• obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician or non-physician practitioner skills.

Per my physician's notes, she wrote that he had "initially significant cerumen, tympanic membranes pearly gray with good landmarks, canals clear". To me, this does not meet the definition of impacted. It was not causing pain or itching, foul odor, or infection. I could maybe see it meeting the last criteria, but she made it seem like the Debrox could remove it just fine at home, but she could do it for me in the office just as a matter of preference, not necessity.

Should I fight this bill and have her change the diagnosis code to non-impacted per her physician notes?

submitted by /u/redditismyforte22
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