Otolaryngology Coding Alert

Question: Is meatoplasty (69310) incidental to tympanoplasty (69646), or should I appeal if I bill both and the payer rejects 69310?


Georgia Subscriber


Answer: Yes, in most cases meatoplasty (69310, Reconstruction of external auditory canal [meatoplasty] [e.g., for stenosis due to injury infection] [separate procedure]) is incidental to tympanoplasty (69646, Tympanoplasty with mastoidectomy [including canalplasty, middle ear surgery, tympanic membrane repair]; radical or complete, with ossicular chain reconstruction).

Code 69310 is a designated -separate procedure,- which means that you can bill it only if it is the only procedure the physician provides in a given anatomical area. The procedure is automatically included in any more extensive procedure provided in the same area during the same operative session.

Therefore, you shouldn't have billed this combination in the first place, and you shouldn't appeal rejections of 69310 with 69646 (or any other, more extensive procedure).

Different location matters: If the surgeon performs the meatoplasty on the right ear, for instance, and the tympanoplasty on the left ear, you can report the procedures separately because they occurred in different anatomical areas. You would report 69646 with modifier LT (Left side). You would report 69310 with modifiers 59 (Distinct procedural service) and RT (Right side).

By using modifier 59, you indicate that the procedures are separate, with the location modifiers providing further proof of this by indicating that the meatoplasty and tympanoplasty occurred on separate (contralateral) sides.