Reader Questions: Myringotomy or Tymp? Look for PE Tube

Question: How do 69421 and 69436 differ?

Ohio Subscriber

Answer: Codes 69421 (Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia) and 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia) are similar in two aspects. Both codes involve an incision into the tympanic membrane or ear drum (myringoplasty), and both contain the word "tube" in their descriptors.

Code 69436 specifically describes a myringotomy with insertion of a ventilating or pressure equalizing (PE) tube. The surgeon inserts a tiny drainage tube to relieve chronic ear infections. CPT uses the term "tympanostomy" for a myringotomy with tubes.

On the other hand, 69421 describes a myringotomy with no tube placement. The surgeon may inflate the patient’s eustachian tube (the internal channel between the middle ear and the nasopharynx).

Thus, the key difference between the codes is whether the surgeon places a tube (artificial) (69436) or not (69421).

-- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.