# Removal of Ventilation tube in Canal



## ASC CODER (Aug 9, 2010)

The right ear was first evaluated. The canals were cleared of all cerumen. The TMs were visualized. The right had a retained tube in the anterior superior aspect of the eardrum. This was removed with a Rosen needle with gentle elevation, followed subsequently by removal. There was an epithelial callus around the previous tube site. This was removed using a Rosen needle, as well as a small cup forceps for site preparation. Topical Ciprodex was then applied, with excess removed. Subsequent paper patch was then placed in an overlay technique and adequately positioned using the operative microscope. 

Focus was then focused to the left ear where the canal did demonstrate some dry debris. This was removed. Immediately, there was an extruded tube that had some mild purulence around this. This was removed. The eardrum seemed to be intact, with a small amount of granulation tissue present over the anterior superior quadrant. There was no evidence of any perforation in situ. The remaining portion of the canal was then further débrided, and then topical Ciprodex applied. 


69610 Rt

but all he did on the left is debride and take the tube out 69220? 69205?
He didn't do myringotomy on Lt...and that is bundle with 69610 on rt....


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## delphinus777 (Aug 11, 2010)

Maybe I am missing something... I didnt read there was a perforation in the right to warrant 69610.  Shouldnt both be 69424? Debridement included as well as the patch for the hole from the tube.


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## ASC CODER (Aug 11, 2010)

in 69424 doesn't that require removal of tube from the EAR DRUM because in the left he removed it from the canal. and I see what you are saying about the perf. but if he removed the tube from the anterior superior aspect of the ear drum that would leave a perf. Correct???


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## delphinus777 (Aug 11, 2010)

In some cases a patch is used. Its the decision the surgeon makes. Here is a good article: http://archotol.ama-assn.org/cgi/reprint/124/4/417.pdf
Also, with the left ear the Dr. states after removing dry debris in the canal "there was an extruded tube". Not sure where it was extruding from but after she/he removed it they stated "The eardrum seemed to be intact" and then commented "There was no evidence of any perforation in situ".  That just leads me to believe it was in the ear drum too.  This is just my interpretation. Maybe question the surgeon. Hope this helps


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## ASC CODER (Aug 11, 2010)

extruded tube means it was already pushed out of the ear drum and sitting in the ear canal among debri thats why I am stuck with removing the tube from the canal and not the eardrum.


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