Otolaryngology Coding Alert

Question: For 69436, can we charge for the first postoperative visit after the 10-day post-op period expires? For example, if the first visit is after the 10 days, can we use an E/M code, or is the first visit inclusive and considered postoperative?

Montana Subscriber

Answer: Although the Medicare Physician Fee Schedule gives tympanostomy code 69436 (Tympan-ostomy [requiring insertion of ventilating tube], general anesthesia) 10 global days, many private payers have 15 days. Consequently, you should collect data on your carriers'guidelines. If you don't know a payer's policy, assume it follows Medicare's 10-day global period and report ventilating tube follow-up services starting on the 11th day. You may then bill the patient based on the evaluation of benefits.

Four to six months after surgery, otolaryngologists usually check children who require tube placements. You should report these visits with the appropriate office visit code (99211-99215, Office visit for an established patient). Make sure to use the original otitis media diagnosis (382.9, Unspecified otitis media) to explain the reason for the visit.