Otolaryngology Coding Alert

Question: How should we bill for the removal of bilateral PE tubes that were initially inserted more than a year ago?

Carrie Cardin, CPC
St. Lucie-Martin Otolaryngology, FL

Answer: PE tubes that were put into a patients ear to prevent infection during a tympanostomy (69436) eventually need to be removed. But the removal of the PE tubes is part of that procedure, says Joan Benham, a coding and reimbursement training specialist with the University of Texas Medical Branch in Galveston, TX.

Often a physician will perform an examination to ensure, among other things, that the membranes are properly closed, but that exam also is part of the original procedure and usually cant be billed separately, unless the circumstances are highly unusual. If general anesthesia is used, a 92502 (otolaryngologic examination under general anesthesia) may be claimed and should be accompanied by an operative note.

Otherwise, unless there is a new, underlying condition the physician is investigating or treating at the same time, there would be no other additional charge, even if the tubes are removed a year or more later.

Note: If a different physician removes the tubes, he or she should bill 69424 (ventilating tube removal when originally inserted by another physician).