Otolaryngology Coding Alert

Question: A patient returns to our office for debridement two weeks after undergoing tympanoplasty with mastoidectomy (69641). Can I bill CPT^® code 69220 for the postoperative cleaning following the tympanic membrane reconstruction?

New Jersey Subscriber

Answer: First, ask yourself if the two procedures are related. In this case, the post-op debridement is related to the initial procedure, so your next move is to look at the specific code’s global period to determine whether 69220 (Debridement, mastoidectomy cavity, simple (eg, routine cleaning)) is billable. You will find that 69641 (Tympanoplasty with mastoidectomy … without ossicular chain reconstruction) has a global period of 90 days. Since the debridement falls within the tympanoplasty code’s global period, you should not report 69220 separately.

But if there was a reason, something clinical about the case, that warranted a planned postsurgical debridement when one would not normally be performed so soon, then the debridement would be considered staged. You could then code 69220 and bill it with modifier 58 (Staged or related procedure or service by the same physician … during the postoperative period).

Hypothetical: If the patient returns within the global period to have an unrelated procedure on the same ear as the prior tympanoplasty and mastoidectomy or the opposite ear, you will want to submit the procedure code with modifier 79 (Unrelated procedure or service by the same physician … during the postoperative period). And if an evaluation and management (E/M) service is performed for a complaint related to the other ear (or the nose or throat), you would need to append modifier 24 (Unrelated evaluation and management service by the same physician … during a postoperative period) to the E/M to indicate it is unrelated to the global. But if the doctor is caring for the ear that had surgery during the E/M, then it is considered a postoperative included service and not separately coded or billed.