Otolaryngology Coding Alert

Question: The otolaryngologist administered a transtympanic injection of a steroid for sudden hearing loss, but did not make an incision in the eardrum. How do we report this?

North Carolina Subscriber

Answer: The correct choice is to code a transtympanic (TM) injection of drugs, such as steroids, with 69801 (Labyrinthotomy, with perfusion of vestibuloactive drug[s]; transcanal). A labyrinthotomy is a surgical incision into the labyrinth (the inner ear). Instead of opening up the ear with a myringotomy type of incision, the doctor used the needle of the syringe to go through the tympanum and deliver the drug.  Even though 69801 is a surgical procedure, it also can be used with in–office procedures because it includes perfusion of drugs.

Tip: Don’t overlook billing some related items in addition to 69801. For instance, you may also report any balance or hearing testing as indicated. Also, use the J code for the drugs, such as:

• Decadron with J1100 (Injection, dexamethasone sodium phosphate, 1 mg)
• Depo-medrol using J1020, J1030, or J1040 (various dosages of Injection, methylprednisolone acetate)
• Gentamicin with J1580 (Injection, garamycin, gentamicin, up to 80 mg).

Caution: Code 69801 used to have a 90-day global period, but that changed. Since it now has a zero-day global period, you may charge both the perfusion, 69801 plus the drug every time you provide the service. This is especially helpful since payers look for a procedure when you bill the “J” codes for the drugs which caused problems when the procedure had a 90 day global and just the drugs were charged for subsequent infusions.

Payment protector: Before providing this service, check that the patient’s policy covers 69801 with a diagnosis of sudden hearing loss (388.2, Sudden hearing loss, unspecified). If the insurer restricts the TM injection to Meniere’s disease (386.00-386.04), obtain advance beneficiary notice for a Medicare beneficiary or use the equivalent insurer patient financial responsibility statement for a private-pay patient.