Otolaryngology Coding Alert

Otolaryngologists should watch for the new ventilating tube definition change in CPT 2003. It allows any physician to bill for the removal as long as he or she performs the procedure under general anesthesia. In addition, CPT Codes 2003 introduces several revised and new codes that impact otolaryngology:
    the skin end point titration test code has been revised to specify the number of tests a new Evaluative and Therapeutic Services section includes codes for postsurgery services associated with cochlear implants and for evaluation and swallowing studies (see article 3) measurement of lesions is now based on the excised diameter (see article 4).

The codes become effective Jan. 1, 2003. Carriers have until April to implement the codes, so check with your payers before using them. Bill for Same-Physician Ventilating Tube Removal In 2003, otolaryngologists will be able to use 69424 (Ventilating tube removal requiring general anesthesia) for removing a ventilating tube when the physician performs the procedure under general anesthesia, regardless of whether the physician who originally inserted the tubes also removes them. Previously, only a different physician than the doctor who placed the tubes could report 69424.

"Finally, our doctors can get paid when they are the physician who put in the tubes and are now taking them out, if they need to use general anesthesia," says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. "This is a major win for otolaryngology practices."

Added language, which follows the revised definition, clarifies that the pressure equalizing (PE) tube removal code is for a unilateral procedure. For a bilateral tube removal, report 69424 with modifier -50 (Bilateral procedures), according to CPT 2003. In addition, CPT makes 69424 impossible to report with other ear procedures. A note following the unilateral instruction states you cannot report 69424 with a foreign-body removal under anesthesia (69205), cerumen removal (69210), myringotomy (69420-69421), tympanostomy or tympanoplasty (69433-69676), hearing device implantation/removal/replacement (69710-69718), facial nerve decompression/suture (69720-69745) and inner-ear procedure (69801-69930). The do-not-report instruction makes 69424 similar to a separate procedure, Cobuzzi says: "You cannot get paid for PE tube removal when it is performed with any of the other ear procedures." Remember, however, when an otolaryn-gologist removes a tube from one ear and performs a different procedure on the other ear, you should report both procedures and append modifier -59 (Distinct procedural service) to the lower-valued code, she says. For instance, an otolaryngologist removes a ventilating tube from a 3-year-old girl's left ear. While the patient is under general anesthesia, the physician removes a tube and places a paper [...]