Otolaryngology Coding Alert

Question: Our surgeon wants to code a pharyngoplasty, but I’m unsure as to whether or not the documentation supports it. The dictation reads:

“Attention was turned to the lateral pharyngeal walls. The eustachian tube was obstructed by extensive hypertrophied musculature. I used the frontal sinus balloon to insert the FiberTape wire approximately 1.3 cm into the canal. Both eustachian tubes were then dilated to 10 atmospheres of pressure.”

Georgia Subscriber

Answer: The application of code 42950 (Pharyngoplasty, [plastic or reconstructive operation on pharynx]) is certainly not appropriate in this case. In order to code a pharyngoplasty, the physician’s primary objective is to perform plastic or reconstructive surgery on the pharynx in order to alter the shape of the soft palate and pharynx.

In order to code this procedure correctly, however, the rest of the operative note is necessary to determine the route in which the eustachian tubes are approached. If the physician performed the procedure via a transnasal approach (by way of the lateral pharyngeal wall), it would be appropriate to code as 69799 (Unlisted procedure, middle ear). Up until 2015, this procedure had been coded as 69400 (Eustachian tube inflation, transnasal; with catheterization). You will want to submit this code alongside documentation of the procedure in order to receive a similar reimbursement.

The alternate approach would be via the ear canal. You will also code this as 69799. Under the physician’s guidance, you will want to utilize the operative notes to determine which existing (or deleted) CPT^® code is most appropriate to submit as a comparison code.