Otolaryngology Coding Alert

Question: How should we code for pressure-equalizing (PE) tube insertion (tympanostomy)? What about ear tube removals?

AAPC Forum Participant

Answer: The correct codes for ventilating (ear) tube insertion and removal depend on the encounter specifics. Check out this quick lesson on the ins and outs of ear tube procedures:

Tube insertion: When the otolaryngologist performs tympanostomy with local anesthesia in the office, report 69433 (Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia). When done under general anesthesia, use 69436 (… general anesthesia).

Remember: CPT^® codes 69433/69436 represent a unilateral insertion, so if you are reporting tympanostomy for both ears, append modifier 50 (Bilateral procedure) or -LT (Left side) and -RT (Right side), depending on payer preference.

Note that Medicare boosts reimbursement for PE tube insertion by 65 percent (2.13 relative value units) over the facility fee assigned when the procedure is performed in the office. This increase is built into the non-facility fee in order to pay the provider for the cost of supplying the tube in the office.

Tube removal: PE tube removals are so common and usually so uncomplicated that the service often is done in the office with local anesthesia. Under those circumstances, the removal is included in the applicable evaluation and management (E/M) code 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) instead of reported separately.

If the tube removal requires general anesthesia, however, you’ll report it with 69424 (Ventilating tube removal requiring general anesthesia) instead of an E/M code. Your otolaryngologist will perform this procedure in the OR, not the office. As with insertions, submit 69424 with modifier 50 or LT/RT appended to when the ENT removes PE tubes bilaterally.

Also note: Tube removal does not have to be performed by the same physician who originally inserted them. Any physician who removes the tubes under general anesthesia can report 69424 for the service.