Otolaryngology Coding Alert

Question: An otolaryngologist makes an incision to retract a ventilating tube that was behind the ear drum. He also does a paper patch. May I report a foreign- body removal code for the tube removal?

Another otolaryngologist outside of our practice placed the tube.


Maryland Subscriber


Answer: You should bill only the ear repair, not the tube removal.

First, you should not consider a ventilating tube a foreign object. A surgeon placed the tube even if it did move from its intended location. In contrast, a foreign body is something that a physician does not intend to be in the body, such as a marble or coin that a child swallows or puts in her ear or nose. Therefore, you should never use a foreign-body removal code for tube removal.

Which otolaryngologist placed the tube is also irrelevant to your coding. CPT 2003 changed the code for ventilating tube removal. Prior to 2003, only a different physician from the doctor who placed the tubes could report 69424 (Ventilating tube removal requiring general anesthesia).

Current method: An otolaryngologist can now use 69424 anytime he removes a ventilating tube, if he performs the procedure under general anesthesia. Because the removal in your example involves general anesthesia, the procedure by itself qualifies for 69424.

Catch: The otolaryngologist in your example also patches the ear drum. Because the National Correct Coding Initiative bundles tube removal (69424) into the ear patch (69610, Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch), you should not bill 69424.

CMS reasons that the otolaryngologist must remove the tube prior to patching the ear drum, and thus makes 69424 a component of 69610. Therefore, you should code a tube removal with ear drum patch as 69610.

Also: If the otolaryngologist spends 25 percent or more time on the surgery for the patch than 69610 normally involves, you may append modifier 22 (Unusual procedural services) to 69610. Documentation must show the eardrum patch's added complexity including the work the otolaryngologist performed to retrieve the tube. Send a cover letter explaining the case's complexity and unusual nature.

The insurer will pay you the normal price on initial submission. You will then have to appeal for additional 69610-22 reimbursement.