Otolaryngology Coding Alert

Question: What is the difference between 69421 and 69436?

Ohio Subscriber

Answer: Code 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia) is for a myringotomy with insertion of a ventilating or pressure equalizing (PE) tube, but 69421 (Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia) describes a myringotomy with no tube placement. CPT uses the term -tympanostomy- to represent a myringotomy with tubes: 69436.

Codes 69421 and 69436 are similar in two aspects. Both codes involve an incision into the tympanic membrane or ear drum (myringoplasty) and contain the word -tube- in their descriptors. In 69421, the surgeon may inflate the patient's eustachian tube, the internal channel between the middle ear and the nasopharynx.

But in 69436, the surgeon inserts a tiny drainage tube to relieve chronic ear infections. Thus, the key difference is whether the surgeon places a tube (artificial) (69436) or not (69421).

Test your 69421 and 69436 coding skills with this note:

-Procedure: Bilateral myringotomy with PE tube placement.

-I evaluated the right ear, removed cerumen and performed anterior-inferior myringotomy. I suctioned mucoid fluid from the middle ear space and inserted a collar button tube.

-I turned my attention to the left ear and performed anterior-inferior myringotomy. I suctioned mucoid fluid from the middle ear space and inserted a collar button tube.-

Although your otolaryngologist refers to these procedures as a myringotomy, he is really performing -- in CPT terms -- tympanostomy. Because the surgeon places PE tubes, you should report 69436 bilaterally (modifier 50), instead of 69421-50. Show your physician the confusion that using -myringotomy- instead of -tympanostomy- causes and encourage him to use the coding nomenclature, rather than the clinical term.