Otolaryngology Coding Alert

Question: Our surgeon performed a tube insertion on a patient in the office, and I thought the correct codes were 69433 with 99070, but my office manager said I-m wrong. Is the reimbursement for the actual tube itself included in the allowance for the procedure?

New Jersey Subscriber
 
Answer: You should report 69433 (Tympanostomy [requiring insertion of ventilating tube], local or topical anesthesia) when you insert tubes as an office procedure, but you should not report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]). 
 
When your surgeon performs a procedure in the office setting, Medicare allows you a higher RVU than it would if the ENT inserted the tubes in a facility. Therefore, the carrier will argue that payment for the tube itself is included in the payment for the procedure. For example, in New Jersey the Medicare fee schedule pays about $62 more when you bill 69433 in the office. That amount should cover the tubes, surgical trays and other supplies.
 
If a private payer does not allow the higher RVU for in-office procedures as Medicare does, you should discuss it with the payer during your next contract negotiation. Show the payer how much you can save their company in anesthesia and facility fees by performing the tube insertion in your office. This way, you can strengthen your case when you try to negotiate a higher office-based tube insertion fee that will cover the cost of the surgical tray and supplies.

 -- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.