Otolaryngology Coding Alert

Question: When coding pressure equalization (PE) tube removals, should we consider the ear tube an implant or a foreign body?

Ohio Subscriber

Answer: An important thing to remember about tympanostomy tube removal is that the PE tube is not considered a foreign body when it’s in place serving its intended function. To clarify the difference between the two terms, CPT^® 2022 added definitions for “foreign body” and “implant” to the Surgery Guidelines:

• An implant is an object placed by a physician for any diagnostic or therapeutic purpose; for example an artificial joint, PE tube, or hypoglossal nerve stimulator.
• A foreign body is any object that is unintentionally placed; for example, swallowing a penny or glass lodged in soft tissue after an accident.

Caveat: According to the updated guideline, “If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes ...”

In other words, if your provider removes a PE tube that has fallen out of the tympanum, CPT^® 2022 seems to instruct you to code the procedure as a foreign body removal and not an implant removal.

Not so fast: But before you go reaching for a foreign body removal code, note it may not always be your best option. The rest of the guideline sentence about broken/dislodged implants states, “… unless CPT^® coding instructions direct otherwise or a specific CPT^® code exists to describe the removal of that broken/moved implant.”

Bottom line: PE tubes that are correctly inserted into the eardrum are not a foreign body. However, if the tube moves from its original position or is structurally broken and no longer serves its intended purpose, it may be considered a foreign body for coding purposes. If there are codes for the removal or repair of a broken or dislodged implant, they should take precedence over codes for the removal of a foreign body.