Otolaryngology Coding Alert

Question: A patient came in for bilateral pressure equalization tube placement. The operative report reads, “After induction of inhalation anesthesia, a microscope was used to clear debris from bilateral external auditory canals. A radial incision was made. Fluid was suctioned and the pressure equalization tube was placed bilaterally.” Would this procedure be considered a myringotomy or a tympanoplasty?

Oregon Subscriber

Answer: You’ve shared limited information about the anatomical location of the procedure, which makes giving a definitive answer challenging. Based on what you said, the most appropriate code probably is 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia). However, double check your physician’s documentation to verify his work fits this code before submitting the claim.

Had the surgeon documented that the amount of debris that needed clearing was excessive and caused the placement of the tubes to take at least 25 percent or more than the average tube placement under general anesthesia, you can consider adding a 22 modifier (Increased procedural services)  The documentation should include a statement that reads something like: “This procedure which normally takes 20 minutes took 40 minutes due to the extensive debris and fluid that needed to be removed and suctioned off from the ear.” Increase your fee by about 50 percent. The practice will probably be paid the normal payer’s fee schedule when it is initially processed and the claim will need to be appealed in order to get the additional money. Use the operative note documentation in your appeal to justify the additional payment.