# dx for tubes



## apollo06 (Jul 3, 2013)

what dx do you use for patients who come in for follow up (way past post op time) of having tubes put in (myringotomy) who show no symptoms of Otitis Media, doing fine.

My providers are using Acute/Chronic Otitis media like they have it but documentation states no recent ear infections.

thank you


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## Candice_Fenildo (Jul 4, 2013)

*Per the Medicare Claims Processing Manual/ Chapter 23*

​Code a chronic condition as often as applicable to the patient's treatment. so until the patient has been discharged and placed on a PRN status for that condition, you would code the diagnosis code that was originally used for that treatment.

Happy 4th!!!


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## mitchellde (Jul 4, 2013)

No you would not code for an infection that no longer exists that is not what that piece in the manual means.  The tubes were put in to prevent further cases of the infection. If the patient presents post op even long after global for a surveillance you use the V code for follow up from surgery. Do not assign a condition that does not exisit


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## Candice_Fenildo (Jul 4, 2013)

Debra, not that I don't believe you, I would like to see a reference to that. 
All of the otolaryngology seminars that I have been to with the AOA and Zupko have always said that? At least that is what I took away from it. 

I am going email the Academy of Otolaryngology tomorrow and see if we can get a better definitive answer. 

It's always nice to hear your thoughts


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## apollo06 (Jul 8, 2013)

Candyr73 can you let me know what the Academy says?  Thank you  I can see it both ways and thats the debate we have going on here at work, any feedback is appreciated.


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## kvangoor (Jul 9, 2013)

I would like to know too!


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## Candice_Fenildo (Jul 9, 2013)

As soon as I hear back, I will post


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## mitchellde (Jul 9, 2013)

the diagnosis is the patient's not the doctors always code from the perspective of the patient.  If they no longer have the condition we do not code it.   You would not code a patient as still pregnant after delivery of the baby.  you do not appendicitis after the appendectomy. and so on.  Post op is coded with V codes for either follow up or aftercare.  This patient no longer has otitis media and it would be irresponsible to indicate that the condition is still present.


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## mitchellde (Jul 23, 2013)

Candyr73 said:


> Debra, not that I don't believe you, I would like to see a reference to that.
> All of the otolaryngology seminars that I have been to with the AOA and Zupko have always said that? At least that is what I took away from it.
> 
> I am going email the Academy of Otolaryngology tomorrow and see if we can get a better definitive answer.
> ...



This issue has been addressed many times in Coding Clinics which are the most definitive source of coding information and answers.
However in the Coding guidelines it states:
There are four primary circumstances for the use of V codes:
1)
A person who is not currently sick encounters the health services for some specific reason, such as to act as an organ donor, to receive prophylactic care, such as inoculations or health screenings, or to receive counseling on health related issues.
2)
A person with a resolving disease or injury, or a chronic, long-term condition requiring continuous care, encounters the health care system for specific aftercare of that disease or injury (e.g., dialysis for renal disease; chemotherapy for malignancy; cast change). A diagnosis/symptom code should be used whenever a current, acute, diagnosis is being treated or a sign or symptom is being studied.

and :
The follow-up codes are used to explain continuing surveillance following completed treatment of a disease,condition, or injury. They imply that the condition has been fully treated and no longer exists. 

When a child has tubes inserted the reason is because they have HAD chronic ear infections, there is never an acute infection at the time of surgery, the follow up encounters are exactly that, follow-up and need to be coded this way.  As I have already stated the patient no longer has the condition of otitis media and it is irresponsisble to continue to code it as a current condition.


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## kvangoor (Jul 29, 2013)

Here is a link to an article I found on supercoder. It states "If the child returns in four to six months for a checkup use 99211-99215 to report the visit. Use the original otitis media diagnosis to explain the E/M visits. Code 382.9 is still appropriate because it explains why the physician is seeing the patient and why she has tubes in her ears."



http://www.supercoder.com/coding-ne...-when-billing-for-postop-tube-removal-article


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## mitchellde (Jul 29, 2013)

I disagree, we must follow the coding guidelines and this condition no longer exisits.  It is a follow up encounter.  The coding guidelines have a statement in the third paragraph of the first page that stated adhearance to the guidelines is required.


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