Otolaryngology Coding Alert

Question: My physician evaluated the patient's right ear and cleared the canal of all cerumen. The tympanic membrane was visualized and had retained a tube. He removed a tube in the anterior superior aspect of the eardrum with a Rosen needle. He removed an epithelial callus around the tube site with a Rosen needle. Ciprodex was applied. A paper patch was then placed in an overlay technique and positioned using the operative microscope. Then the Physician went to the left ear and removed some dry debris. He removed an extruded tube. There was no perforation in situ. He debrided the canal and applied Ciprodex. How do I code this?

Answer: First, code the more complex procedure with 69610-RT (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch; Right side).

Cancel these options: You cannot code for the binocular microscope (92504, Binocular microscopy [separate diagnostic procedure]) as it is a separate procedure and inclusive withany other ear procedure performed. Similarly, the removal of impacted cerumen (69610) is also a separate procedure, and insurers consider it inclusive with any other ear procedure. Also, if the physician performed this service in the operating room (the question does not clarify this), you cannot code 69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) because even though the physician used the operating microscope, coding 69990 requires the use of microsurgical technique. These procedures show no evidence of microsurgery

Secondly, code 69424-59-LT (Ventilating tube removal requiring general anesthesia; Distinct procedural service; Left side) if the physician performed this procedure in the operating room under general anesthesia. If the physician performed this service under local anesthesia in the OR or in the office, you can code it 92504-59-LT for the use of the binocular microscope as you won't find any code for tube removal when the physician does not use general anesthesia.

Normally, if an otologic procedure requires a transcanal or endaural approach with incision of the tympanic membrane and access through the middle ear (69440) and tympanic membrane procedures (69240, 69421, 69433, 69610, 69620), you should not report it separately. However, your physician performed these services on two ears and should be paid for them as separate procedures.

Your claim should look like this:

• 69610-RT
• 69424-59-LT or 92504-59-LT depending on the type of anesthesia the physician used.