Otolaryngology Coding Alert

Question: What is the appropriate CPT® for Silverstein permanent aeration tube? The surgery took 1.5 hours. My physician would like to report 69440 but I'm not so sure.

Maine Subscriber

Answer: You have two choices: (1) use the unlisted codes, or (2)use modifier 22 (Increased procedural service) with 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia) to describe the increased service. Make sure you create a standard letter describing the procedure, what differentiates it from standard tube placement, and the medical benefits for the patient over standard tubes (i.e., why should payer pay for the Silverstein tubes) to use to appeal and get paid appropriately.

Important: If the op note does not show middle ear exploration, you cannot bill 69440 (Middle ear exploration through postauricular or ear canal incision). Even if the op note shows middle ear exploration but does not show medical necessity for doing the exploration, you still cannot code 69440. You must prove the medical necessity of the procedure. Don't report the middle ear exploration if it's not necessary only because it's a higher paying code. It could get you in trouble with your payer.

Option: If the physician placed the patient under local anesthesia, you would use 69433 (Tympanostomy [requiring insertion of ventilating tube], local or topical anesthesia). If the service is more complicated than other tubes, just as mentioned above, use modifier 22. The documentation should show why the service is an increased service.