Otolaryngology Coding Alert

Question: PE tubes were put in a patients ear by another physician who is not in our group. I billed the following: 69424 (ventilating tube removal when originally inserted by another physician); 69610 (tympanic membrane repair, with or without site preparation or perforation for closure, with or without patch). The carrier paid 69610 and denied 69424 as inclusive in 69610. Should we appeal the denial?

Nancy Gleason
Syracuse, NY

Answer: You cant bill both for tube removal and tympanic repair, says Margaret M. Hickey, RN, MSN, MS, president of the Society of Otorhinolaryngology and Head-Neck Nurses and clinical oncology director at Tulane Cancer Center in New Orleans, because you cant perform a tympanic repair without removing the tubes. That means the tube removal is incidental to the eardrum repair, which is reflected in the fact that both procedures are bundled in Medicares national Correct Coding Initiative.