Otolaryngology Coding Alert

Question: An otolaryngologist performs a transtympanic injection - he injects a steroid in the patient's ear. How should I code the procedure?


Colorado Subscriber


 

Answer: You should code the injection with 69801 (Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs [single or multiple perfusions]; transcanal), as well as the medication J code.

 
For instance, report the anti-inflammatory steroid Decadron with J1100 (Injection, dexamethasone sodium phosphate, 1 mg). Other possibilities include Depo-Medrol (J1020-J1040) and Solu-Medrol (J2920, J2930).

Watch out: Report 69801 for only the initial injection. Code 69801's descriptor specifies "single or multiple perfusions." Therefore, even though otolaryngologists perform multiple injections, the first claim includes all subsequent injections.

Code 69801 also contains a 90-day global period, so any other services that the otolaryngologist performs during this time will require a modifier to break the global-day-period bundle, such as modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period).

CORRECTION:   Modifier 52 is unnecessary on steroid injection claims of 69801.
 
Otolaryngology Coding Alert's April 2005 "You Be the Coder: How to Bill a Steroid Injection" erroneously added the reduced service indicator (modifier 52) to 69801 (Labyrinthotomy, with or without cryosurgery including other nonexcisional destructive procedures or perfusion of vestibuloactive drugs [single or multiple perfusions]; transcanal) for a transtympanic injection.
  
The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) does not support the application of modifier 52 with the steroid injection. Otolaryngology Coding Alert concurs with the Academy's recommendation.
 But remember, 69801 contains a 90-day global period. Therefore, you should not bill subsequent injections during this time.
 
You should, however, report the drugs, such as gentamicin (J1580, Injection, Garamycin, gentamicin, up to 80 mg).