Reader Questions: Tube Removal + Placement = 1 Code

Question: Is there a code that insurers will pay for removal of a tube from the ear and replacement with a new tube? I have been using 69205 with 69436, but insurers deny 69205.Illinois Subscriber

Answer: A ventilating tube is not a foreign body. The physician has placed it there to help drain the patient’s ear, so it is a desired, functional device, not an unwanted object. Therefore, you should not use a foreign-body removal code, such as 69205 (Removal foreign body from external auditory canal; with general anesthesia: APC 0022), to describe removing a ventilating tube.

You would instead report tube removal alone with 69424 (Ventilating tube removal requiring general anesthesia: APC 0253).

You should not bill for tube removal (69424) in addition to tube placement (such as 69436, Tympanostomy [requiring insertion of ventilating tube], general anesthesia: APC 0253), according to CPT’s parenthetical instruction following 69424. Tympanostomy includes removal of any previously placed tube. The surgeon cannot place a new tube without first removing an existing tube.

Important: Code 69436 is a unilateral code. If the outpatient physician performs the removal and replacement on both sides, you can report 69436 x 2, as necessary.