# Removal/retained PE tube ear please help!!



## laurabee (May 26, 2009)

I'm coding ASC's and am completely new to coding ear procedures. I don't even know where to begin on this one...

PREOPERATIVE DIAGNOSES:	
1.	Retained left PE tube.
2.	Eustachian tube dysfunction.
3.	Cerumen excess on the right side.

POSTOPERATIVE DIAGNOSES:	
1.	Retained left PE tube.
2.	Eustachian tube dysfunction.
3.	Cerumen excess on the right side.

PROCEDURES PERFORMED:	
1.	Removal of PE tube under general anesthesia.
2.	Retained PE tube on the left side under general anesthesia.
3.	Examination of the ear under anesthesia on the right side.

ANESTHESIA:	General.

ESTIMATED BLOOD LOSS:	Less than 5 cc.

COMPLICATIONS:	None.

OPERATIVE FINDINGS:
1.	Left ear retained tube need to be removed and after tube removal, there was some granulation filling the area where the tubes had been removed on the left side and no myringoplasty was performed.
2.	Some cerumen excess on the right, which was removed in the normal-appearing tympanic membrane on the right side.

INDICATIONS:  The patient is a male with a history of eustachian tube dysfunction.  He had a tube placed and he has had no further problems with the tube on the right side to allow a natural course; however, the tube on the left side has been retained with surrounding granulation tissue and because it was retained for extended period of time, it was decided to have this removed and consent for the above procedure was obtained after the risks, benefits, alternatives, and indications were explained to the patient and his family.

OPERATIVE PROCEDURE:  The patient was taken to the OR suite, placed supine on the operating table.  A general mask anesthesia was smoothly induced by Dr. ___ and a microscope was utilized to visualize the left tympanic membrane.

After shortening of the _____(2:29), the retained PE tube was noted and there was some surrounding granulation tissue and it was removed with an Alligator forceps.  After it was removed, there was some surrounding granulation tissue that filled the place where it was located.  The tympanic membrane and this did bleed easily; however, there was minimal bleeding, which occurred.  Some blocks were then placed and cottonoid was placed in the external auditory canal.  It was decided to place the myringoplasty on the left because of the granulation tissue that clearly was filling the area with the tube using three more adhesions without incident with this healing tissue.  The examination under anesthesia was then performed on the right side.

Microscope was utilized to visualize the right tympanic membrane.  There was some excess cerumen and this was removed and the tympanic membrane did appear normal on the right side.  The patient was then awakened and was taken to the recovery room in stable condition.


I'm thinking 69424 for the removal of PE tube, but I'm confused on a couple of things:

1. Would the dx be 996.79 because it is a complication of an implant (retained implant)?

2. Does the #2 procedure make any sense? Doc says he removed PE tube in #1, then says "Retained PE tube" on same side on #2. But in op notes he says they took the tube out. But he also says they placed a myringoplasty on the left. Is this the same thing as a "retained PE tube"?? Also 69424 & 69620 (69620 is what I got for myringoplasty) can't be billed together per CCI edits.

3. Can I bill for the exam on the right side and/or the removal of excess cerumen? I can't even find the code for exam. 69200 range would fit the removal of excess cerumen but it doesn't say it was impacted, and I also don't know if it can be considered foreign material so I don't know if it would qualify for the other codes in that range. 

Ack!! Help please!!!!!


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## magnolia1 (May 26, 2009)

WOW!!

Okay, you're right....Procedure #2 makes no sense to me either.

Also, assuming that the tube was removed from the tympanic membrane (I think that's what the surgeon is saying), I would use 69424 (if removed from the auditory canal, I would use 69200, 69205). If not clear in the OP report, I 
question the doc.

Because, there is a procedure being done on one ear, I would not be inclined to code an exam on the other ear. I have at times used 92502.


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