Otolaryngology Coding Alert

Question: When we submit 69436 with 69601, UnitedHealthcare (UHC) bundles the tube insertion into the middle ear procedure. I do not see this edit in the Correct Coding Initiative. Should we appeal these denials?

Georgia Subscriber

Answer: You are correct that the current Correct Coding Initiative (CCI) version 14.2 does not consider ventilating tube insertion (69436, Tympanostomy [requiring insertion of ventilating tube], general anesthesia) a component of revision mastoidectomy (69601, Revision mastoidectomy; resulting in complete mastoidectomy). CMS does not include all bundles in CCI.

During a complete mastoidectomy, the otolaryngologist revises a previously performed simple mastoidectomy (69501, Transmastoid antrotomy [simple mastoidectomy]). "A temporary drain may be placed," according to the Coders- Desk Reference. You would include the ventilating tube insertion for drainage as part of the complete mastoidectomy.

UHC explains this principle in its rebundling edits. "The insertion of a tube into the ear for drainage or ventilation following a more intensive surgical procedure should not be reported separately when it does not represent a significant increase in work, practice expense, or malpractice expense."

UHC follows CCI's inclusion of 69436 in these additional middle ear procedures:

- TM repair (69610, Tympanic membrane repair, with or without site preparation or perforation for closure, with or without patch)

- Tympanoplasty without mastoidectomy and without ossiculoplasty (69631, Tympanoplasty without mastoidectomy [including canalplasty, atticotomy and/or middle ear surgery], initial or revision; without ossicular chain reconstruction).