Otolaryngology Coding Alert

Question: Our otolaryngologists commonly perform transtympanic therapeutic injections for conditions such as sudden sensorineural hearing loss and severe cases of vertigo. The patient may need a single injection or a series of injections over multiple months. How is this reported and what are key coding considerations?

Georgia Subscriber

Answer: When ENTs make an incision into the labyrinth (the inner ear) and instill one or more drugs, such as a steroid or an antibiotic, through the tympanic membrane, report 69801 (Labyrinthotomy, with perfusion of vestibuloactive drug(s), transcanal) for each separate encounter/instillation (separate ear, separate day). You’ll also use 69801 when the provider opts to inject the drug with a needle through the tympanic membrane, and in such cases, adding modifier 52 (Reduced services) isn’t necessary.

Pro tips: Do not report 69801 more than once per day and avoid using it in conjunction with 69420 (Myringotomy including aspiration and/or eustachian tube inflation), 69421 (… requiring general anesthesia), 69433 (Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia), and 69436 (… general anesthesia) when performed on the same ear.

Don’t forget the drug: You may report a separate J code for the medication used — for example, Decadron^® (J1100), Depo–Medrol^® (J1020–J1040), Solu–Medrol^® (J2920 J2930), gentamicin (J1580) — and you should submit a drug code for each injection. Make sure to indicate the number of units for the drug amount instilled into the inner ear.

It’s important to note that 69801 has a 0-day global period, so you can bill for the procedure and drug(s) each time the provider performs a transtympanic injection/instillation into the inner ear, which is often once a month for three months.

As always, ensure the documentation fully supports your provider’s treatment rationale and the codes submitted in the claim. Be prepared to send clinical notes if the claims examiner needs further information to process the claim.