# Eustachian tube dilation



## eminey

Has anyone done ET dilation with the Acclarent balloon and if so, how do you code?   Get Pre-D?  I'm having a lot of problems finding where to even begin with this.  Rep said 69799 and 31276.  Just not quite sure about that...  Any ideas?  Thanks!  Also, if you have done this, how is the reimbursement?  This will be done in an ambulatory setting.  Thanks again.


----------



## nina21_bra@hotmail.com

What I do... I go to youtube and see how the procedure is done. That helps with the coding as well


----------



## sisadavis

We have just begun performing this service procedure as of the first of the year.  We are billing the unlisted procedure code 69799 along with a nasopharyngoscopy 92511 and have not seem to had any issues.  I would not bill the 31276, unless this was performed along with FESS procedures, as the ET is accessed through the nasopharynx vs. frontal sinus.


----------



## cwater

*CPT 67999 endoscopic balloon dilation of the Eustachian tubes*

endoscopic balloon dilation of the Eustachian tubes CPT 67999

Can anyone advise what CPT code they are using as a comparable code with similar resources and explain how the procedures are similar in time, skill, and resource utilization?  

Thanks, Camille Waterhouse


----------



## JenniferB7

For anyone who needs supporting documentation:

CPT deleted code 69400 for Eustachian Tube inflation; transnasal; with catherterization beginning in 2015. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), who is responsible for physician board certifications in ENT, states the following: 

Deletion of three Eustachian tube codes (69400, 69401, and 69405). To report the work of 69400 or 69405 an unlisted code, 69799, is recommended. For 69401, the appropriate Evaluation and Management office visit code is recommended. For more, visit our coding corner to access the CPT for ENT on this topic.

Source: http://www.entnet.org/content/cpt-ch...ents-need-know​
Also, CPT states this in their parenthetical notes on page 427 of the 2017 CPT manual: [69400 has been deleted. To report, use 69799]

I would compare code 69799 for dilation with CPT 69420 since the code includes "Eustachian tube inflation."

Hope this helps!

Jennifer M. Connell, CPC, CENTC, CPCO, CPPM, CPMA, CPB, CPC-P, CPC-I


----------



## DonnaReynolds23

*Clarification of ET balloon dilation*

Thanks for all the info. Our office is also just starting to use this device for ET dilation. My question is - what is meant by "eustachian tube inflation" in CPT 69420-69421? 

Thank you in advance

Donna Reynolds, CPC


----------



## DonnaReynolds23

*Pre-determ?*



sisadavis said:


> We have just begun performing this service procedure as of the first of the year.  We are billing the unlisted procedure code 69799 along with a nasopharyngoscopy 92511 and have not seem to had any issues.  I would not bill the 31276, unless this was performed along with FESS procedures, as the ET is accessed through the nasopharynx vs. frontal sinus.



Are you submitting a pre-determ for this procedure? And which insurance carriers are you being successful with?
Thank you


----------



## JenniferB7

The best explanation I have found for this is from the US Library of Medicine (https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013858/)

"Autoinflation is a technique whereby the Eustachian tube (the tube that connects the middle ear and the back of the nose) is reopened by raising pressure in the nose. This can be achieved by forced exhalation with closed mouth and nose, blowing up a balloon through each nostril or using an anaesthetic mask. The aim is to introduce air into the middle ear, via the Eustachian tube, equalising the pressures and allowing better drainage of the fluid."​
The Procedure Desk Reference describes CPT 69421 as follows:

The patient is prepped and draped in a usual sterile fashion. General anesthesia is induced by appropriate anesthetic agent. The physician then treats auditory tube dysfunction or otitis media by dilating  the pharyngotympanic tube and evacuating serous fluid or effusion from the tympanic cavity.​
Hope that helps!


----------



## DonnaReynolds23

thank you for the explanation!


----------



## catherinetinkey@entmedicalservices.org

Using 69421 Myringotomy for the eustachian tube dilation won't work you are going through the nose for the dilation not the ear no incision in the ear made.


----------



## jocoffey

*69799/69436*

Is it appropriate to bill both 69799( dilation of Eustachian tubes) with 69436(insertion of ear tubes) our physician has performed dilation of

           of Eustachian tubes and also inserted ear tubes.  We have used(69421) as a comparison code for 69799- because cpt code 69400 has been

           terminated.   Please advise.


----------



## JenniferB7

jocoffey said:


> Is it appropriate to bill both 69799( dilation of Eustachian tubes) with 69436(insertion of ear tubes) our physician has performed dilation of
> 
> of Eustachian tubes and also inserted ear tubes.  We have used(69421) as a comparison code for 69799- because cpt code 69400 has been
> 
> terminated.   Please advise.



It would depend on how your physician is performing the dilation.   Is he/she doing the dilation via balloon using a nasal endoscope (i.e., the Acclarent system: https://www.laents.com/conditions/eustachian-tube-balloon-dilation/) or is he/she performing the dilation through the incision in the tympanic membrane where the ear tube will be placed?

If you are using the Acclarent system, then you can bill both procedures.   They are two different operative approaches using two different sets of instruments.  Just be prepared to educate your carrier on the dilation procedure.  You may want to consider adding modifier 59 or XU to the Eustachian tube dilation procedure to indicate that it is separate procedure.   Also, if you are performing the dilation by nasal endoscopy, you may want to consider comparing the unlisted 69799 code to a nasal endoscopy code (31231-31237 or one of the endoscopy codes with sinus balloon dilation, 31295-31297).   I would query your surgeon on which of those codes is closest in terms of work, time, intensity and go from there.


----------



## WScheetz

*New HCPCS code effective 7/1/17 for balloon dilation of ETD*

C9745
Nasal endoscopy, surgical; balloon dilation of eustachian tube.  We about to bill for the first time and keeping fingers crossed that there will not be any issues with processing.


----------



## sisadavis

DonnaReynolds23 said:


> Are you submitting a pre-determ for this procedure? And which insurance carriers are you being successful with?
> Thank you



Sorry for the delay in response.  We are submitting for prior-auth.  The only payers we have issues with are UHC and BCBS of Nebraska.  Otherwise we have seen reasonable reimbursement from most commercial payers.  Medicare does not pay much and they are treating as a major procedure with a 90 day global.  If you are using the device from Acclarent, they have a great billing and coding guide available online!


----------



## mjspidey

sisadavis said:


> Sorry for the delay in response.  We are submitting for prior-auth.  The only payers we have issues with are UHC and BCBS of Nebraska.  Otherwise we have seen reasonable reimbursement from most commercial payers.  Medicare does not pay much and they are treating as a major procedure with a 90 day global.  If you are using the device from Acclarent, they have a great billing and coding guide available online!



Are you billing for the physician or facility?  What is the average reimbursement you are seeing for the ETD procedure?


----------

