Otolaryngology Coding Alert

Question: My doctor performed a left tympanoplasty with a stapes mobilization. He did not perform a mastoidectomy or ossicular chain reconstruction. He inserted a canal tube. How should I bill this?

Nebraska Subscriber
 
Answer: Because your otolaryngologist performs tympanoplasty alone, you should report 69631 (Tympanoplasty without mastoidectomy [including canalplasty, atticotomy and/or middle ear surgery], initial or revision; without ossicular chain reconstruction). If the otolaryngologist performs a more complete surgical procedure, for instance, tympanoplasty with mastoidectomy, you should report the combination code (69641, Tympanoplasty with mastoidectomy [including canalplasty, middle ear surgery, tympanic membrane repair]; without ossicular chain reconstruction). Or suppose, in addition to tympanoplasty, the surgeon repairs a defect with ossicular chain reconstruction. In this case, you should assign 69632 ( with ossicular chain reconstruction [e.g., postfenestration]).

The tympanoplasty code (69631) includes the tube placement, according to the National Correct Coding Initiative (NCCI). The edits bundle pressure equalizing (PE) tube placement code 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia) into tympanoplasty without mastoidectomy code 69631. Therefore, you should not separately report 69436 to Medicare and payers that follow NCCI.

On the other hand, you should separately report the stapes mobilization. Because 69631 does not include remobilizing the stapes footplate, you should report the subsequent procedure with 69650-51 (Stapes mobilization). You should append modifier -51 (Multiple procedures) to the lesser-valued procedure the stapes mobilization (69650-51) to indicate a multiple procedure performed on the same day of the tympanoplasty (69631).