Otolaryngology Coding Alert

Question: How should we code for in-office insertion of ventilating ear tubes (tympanostomy)? What about ear tube removals?

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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).

Remember: These codes are for unilateral insertion, so if you are reporting tympanostomy for both ears, report 69433 once with modifier 50 (Bilateral procedure) appended to show that the otolaryngologist performed insertion on both ears. You will find that Medicare has a 54% (2.31 RVU) increase over the facility fee assigned for putting tubes in the ears when the procedure is performed in the office. This increase in fee 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: When the physician or other provider removes ventilating ear tubes in the office, you’ll typically report the appropriate-level evaluation and management (E/M) code from the 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making …) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity …) code set.

If the provider needs to use general anesthesia to facilitate tube removal, report 69424 (Ventilating tube removal requiring general anesthesia) instead. It does not matter if the surgeon removing the tubes was the surgeon who put the tubes in. That distinction was removed from CPT^® descriptions years ago.

Remember: The 69424 code is a unilateral code, so if you are reporting tube removal under general anesthesia for both ears, report 69424 once with modifier 50 appended to show that the otolaryngologist performed removal on both ears.