Otolaryngology Coding Alert

Question: Is there a code that insurers will pay for removal of a tube from the ear and replacement with a new tube? I have been using 69205 with 69436, but insurers deny 69205.

Illinois Subscriber

Answer: A ventilating tube is not a foreign body. An otolaryngologist has placed it there to help drain the patient's ear. So it is a desired, functional device, not an unwanted object, such as a bead. Therefore, you should not use a foreign-body removal code, such as 69205 (Removal foreign body from external auditory canal; with general anesthesia), to describe removing a ventilating tube. You would instead report tube removal alone with 69424 (Ventilating tube removal requiring general anesthesia).

You should not bill for tube removal (69424) in addition to tube placement (such as 69436, Tympanostomy [requiring insertion of ventilating tube], general anesthesia), according to CPT's parenthetical instruction following 69424. Tympanostomy includes removal of any previously placed tube. The surgeon cannot place a new tube without first removing an existing tube.

Important: Code 69436 is a unilateral code. If the otolaryngologist performs the removal and replacement on both sides, you can report a bilateral procedure with modifier 50 (Bilateral procedure): 69436-50.

Catch: If your physician replaces a tube on one ear and only removes a tube without replacing it in the other ear, you can code both sides. Use either the body-side modifiers or modifier 59 (Distinct procedural service) depending on your payer's modifier processing policies. Therefore, you can report this scenario as 69436-RT (Right side) with 69424-LT (Left side). If your payer does not recognize the RT and LT modifiers- individual nature and bundles the left tube removal with the right tube's placement, you may instead code the scenario as 69436 and 69424-59.

Modifier 59 indicates that the physician performed the tube removal on a different body location from the insertion (even if the physician performed a removal at that location as well).