# Tympanostomy Dx Codes



## purinoski

Doc replaces PE tube which was occluded with debris and also effusion in middle ear space.  My dx sequencing is 1) 996.79 2) 381.4.  Doc has problem with 996.79 because it is a complication code and only wants to use 381.4.  996.79 has not been added to his clinic's billing system.  Will have meeting with doc but wanted to find out what anyone else thinks.
Thanks,
Phyllis Urinoski, CPC


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## mbort

if he is taking one out and replacing it with another, I would consider dx code 385.83 as a 2nd diagnosis.

Because the removal of the PE tube (69424) bundles into the replacement (69436), I would use the 381.5 as primary dx and 385.83 as 2nd.


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## purinoski

385.83 is retained foreign body, tubes are not foreign bodies - a surgeon puts them in for a reason.  A foreign body is something that is not supposed to be there, like a bead or seed, etc.  If anybody would code the same as I did, please let me know.
Thanks,
Phyllis Urinoski


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## elenax

If the replacement of the tube was due to failure of the first surgery, then I would use the complication code; in other words I agree with your coding.


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## mbort

I agree with your coding if there "was" a complication.  However if there is not a complication, then I would use the 385.83.

I disagree, a tube is a retained foreign body.  I know the surgeon puts them there for a reason.  If you check the cross coder (which I have included in this post) for diagnosis for removal of PE tubes, you will find the diagnosis 385.83   I dont think that CPT would have put that diagnosis in the cross coder if it did not apply.  

Cross Coder - 69424 


  ICD-9-CM VOL 1 CODES  
  ICD-9-CM VOL 3 CODES  
  HCPCS CODES  
  ANESTHESIA CODES  




Code  Description  
381.10  Simple or unspecified chronic serous otitis media  
381.20  Simple or unspecified chronic mucoid otitis media  
381.29  Other chronic mucoid otitis media  
381.3  Other and unspecified chronic nonsuppurative otitis media  
381.4  Nonsuppurative otitis media, not specified as acute or chronic  
381.81  Dysfunction of Eustachian tube  
382.00  Acute suppurative otitis media without spontaneous rupture of eardrum  
382.1  Chronic tubotympanic suppurative otitis media  
382.2  Chronic atticoantral suppurative otitis media  
385.83  Retained foreign body of middle ear  
388.60  Unspecified otorrhea  
388.71  Otogenic pain  
996.69  Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft  
996.79  Other complications due to other internal prosthetic device, implant, and graft  
V53.09  Fitting and adjustment of other devices related to nervous system and special senses  
V58.49  Other specified aftercare following surgery


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## purinoski

You may be right about foreign body, but I was going by an "Otolaryngology Coding Alert Index No. 12942" put out by The Coding Institute and quoting The American Academy of Otolaryngology - Head and Neck Surgery.  Surgical Cross Coder is put out by INGENIX as a reference tool and I do use them, but as always we have to be careful in using them correctly

My original question was referring to a replacement of tube due to occlusion of the tube with debris and effusion.

Thanks for your input.


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## lcaldw01

It specifically said in the documentation I am coding removal of a foreign body and retained PE tubes..I was going to use 3829 and 38583


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