Primary Care Coding Alert

Question: Our family physician documented the following note: -An impacted foreign body (FB) that appeared to be a seed was lying within the ear canal. After I removed the FB, I performed a tympanostomy and inserted a tube.- We reported 69205 and 69436, but the insurer denied 69205, stating that the service is included in the tympanostomy. NCCI does not bundle the codes. What could I have done wrong? 


Kansas Subscriber

Answer: You are correct that the National Correct Coding Initiative does not bundle 69205 (Removal foreign body from external auditory canal; with general anesthesia) into 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia).

There is a good chance that the insurer assumes that your physician removed an old tube and that you are reporting 69205 to reflect that service. If you removed an old tube and replaced it with a new one, the insurer would bundle the tube removal, and you could not report the foreign-body removal code 69205 to collect for the old tube removal.

Some payers have instituted their own edits to combat the problem of practices billing 69205 for tube removals, and that may be the case with your insurer. You should appeal the denial with a copy of your physician's documentation showing that the FB was a seed, not an
old tube.