Otolaryngology Coding Alert

Question: A physician in my office always wants to bill 69440 (middle ear exploration through postauricular or ear canal incision) with 69643 (tympanoplasty with intact or reconstructed wall, without ossicular chain reconstruction) and 69644 (with ossicular chain reconstruction). Although they arent bundled according to the national Correct Coding Initiative (CCI), is 69440 nevertheless considered a component of these two codes? In addition, would 69436 also be considered a component of 69643 or 69644?

Louisiana Subscriber

Answer: As comprehensive as the CCI is, it does not include every code combination that should be bundled. Sometimes CCI does not edit codes even though one code quite obviously is a component of the other. That is the case here, says Barbara Cobuzzi, MBA, CPC, CPC-H, an independent otolaryngology coding and reimbursement specialist in Lakewood, N.J. The description of 69440 in Coders Desk Reference clearly states, No major treatment is rendered at this time. In other words, says Cobuzzi, 69440 is used for exploration only with no treatment performed. This may occur when the otolaryngologist sees a patient with unexplained conductive hearing loss. The otolaryngologist performs an exploratory tympanotomy, determines the patient has otosclerosis, closes the patient and then schedules surgery for the problem at a later date.

The edit is derived not from the CCI, Cobuzzi says, but from clinical experience. In this way, it is similar to that of the middle turbinectomy performed during an ethmoidectomy that is also bundled because the turbinate is removed to provide access to the ethmoid sinuses and, as such, is a necessary component of the primary procedure.

Note: Inferior turbinates should be separately payable because they are not removed for reasons of access.

In short, if a surgical procedure (i.e., tympanoplasty, mastoidectomy or stapedectomy) is performed, 69440 should not be billed because it is a necessary component of the primary service, Cobuzzi says.