Otolaryngology Coding Alert

Question: Prior to performing a tympanostomy with tube placement, the provider performed a cerumen removal service and a myringotomy of the same ear. Can I bill out all three procedures?

Oklahoma Subscriber

Answer: Actually, you should only bill out with one code, 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia) or 69433 (Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia), depending on if anesthesia is applied.

With respect to the myringotomy, 69420 (Myringotomy including aspiration and/or eustachian tube inflation) and 69421 (Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia) are fundamental components of the tympanostomy with tube placement procedure.

Additionally, removal of any impacted cerumen via code 69210 (Removal impacted cerumen requiring instrumentation, unilateral) is also a necessary component of the underlying tympanostomy procedure. Before performing the myringotomy, the provider will remove any impacting or obstructing cerumen in order to clear the passageway.

Fortunately, for those coders who do mistakenly bill one or both of these procedures alongside one another, there are Correct Coding Initiative (CCI) edits in place to flag this claim before payment is processed. Codes 69420/69421 and 69210 are column 2 codes, which means that an overriding modifier is necessary to distinguish the procedures as a separately identifiable, distinct procedural service. In this case, these procedures are interlinked, so a modifier 59 (Distinct procedural service) or an X{EPSU} modifier is not applicable.

Caveat: If the physician performs cerumen removal or a separate myringotomy on the opposite ear of the tympanostomy, you may bill separately for the services. However, 69210 is still an included component of 69420 and 69421, so do not bill the cerumen removal separately when performed with a myringotomy. If the physician performs either procedure on the unilateral ear, you should apply the respective unilateral modifier code, LT (Left Side) or RT (Right Side).