Otolaryngology Coding Alert

Question: The surgeon made a transcanal incision lateral to the apparent osteoma. The ear canal skin was elevated over it. He removed the osteoma. During the procedure the surgeon discovered that the patient did not have a narrow medial stalk, that it extended all the way down to the malleus and the anterior ear canal. He drilled out the remained of the osteoma and atresia down to the tympanic membrane, freeing the malleus from its attachment. He did not enter the middle ear cavity during the procedure. The surgeon suctioned fluid from the middle ear through a miniscule superior attic defect without injuring the residual tympanic membrane. Because of the nature of the atresia and the minimal view anteriorly, he decided to not insert a tympanostomy tube. 

The doctor said I should code 69140 but I was looking at 69320. What do you think?

Vermont Subscriber

Answer: You are correct in thinking that 69320 (Reconstruction external auditory canal for congenital atresia, single stage) best describes the procedure. The physician performed surgical reconstruction of the external acoustic meatus for correcting a congenital anomaly of the external ear that was impairing the patient’s hearing. It’s a more detailed code and better description of the service than 69140 (Excision exostosis[es], external auditory canal).