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#1
10-17-2008, 10:24 AM
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Tympanostomy Dx Codes
Doc replaces PE tube which was occluded with debris and also effusion in middle ear space. My dx sequencing is 1) 996.79 2) 381.4. Doc has problem with 996.79 because it is a complication code and only wants to use 381.4. 996.79 has not been added to his clinic's billing system. Will have meeting with doc but wanted to find out what anyone else thinks.
Thanks, Phyllis Urinoski, CPC 
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#2
10-17-2008, 02:53 PM
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if he is taking one out and replacing it with another, I would consider dx code 385.83 as a 2nd diagnosis.
Because the removal of the PE tube (69424) bundles into the replacement (69436), I would use the 381.5 as primary dx and 385.83 as 2nd. Last edited by mbort; 10-17-2008 at 02:56 PM.
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#3
11-11-2008, 06:39 PM
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385.83 is retained foreign body, tubes are not foreign bodies - a surgeon puts them in for a reason. A foreign body is something that is not supposed to be there, like a bead or seed, etc. If anybody would code the same as I did, please let me know.
Thanks, Phyllis Urinoski
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#5
11-12-2008, 08:45 AM
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I agree with your coding if there "was" a complication. However if there is not a complication, then I would use the 385.83.
I disagree, a tube is a retained foreign body. I know the surgeon puts them there for a reason. If you check the cross coder (which I have included in this post) for diagnosis for removal of PE tubes, you will find the diagnosis 385.83  I dont think that CPT would have put that diagnosis in the cross coder if it did not apply. Cross Coder - 69424 ICD-9-CM VOL 1 CODES ICD-9-CM VOL 3 CODES HCPCS CODES ANESTHESIA CODES Code Description 381.10 Simple or unspecified chronic serous otitis media 381.20 Simple or unspecified chronic mucoid otitis media 381.29 Other chronic mucoid otitis media 381.3 Other and unspecified chronic nonsuppurative otitis media 381.4 Nonsuppurative otitis media, not specified as acute or chronic 381.81 Dysfunction of Eustachian tube 382.00 Acute suppurative otitis media without spontaneous rupture of eardrum 382.1 Chronic tubotympanic suppurative otitis media 382.2 Chronic atticoantral suppurative otitis media 385.83 Retained foreign body of middle ear 388.60 Unspecified otorrhea 388.71 Otogenic pain 996.69 Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft 996.79 Other complications due to other internal prosthetic device, implant, and graft V53.09 Fitting and adjustment of other devices related to nervous system and special senses V58.49 Other specified aftercare following surgery
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#6
11-13-2008, 01:46 PM
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You may be right about foreign body, but I was going by an "Otolaryngology Coding Alert Index No. 12942" put out by The Coding Institute and quoting The American Academy of Otolaryngology - Head and Neck Surgery. Surgical Cross Coder is put out by INGENIX as a reference tool and I do use them, but as always we have to be careful in using them correctly
My original question was referring to a replacement of tube due to occlusion of the tube with debris and effusion. Thanks for your input.
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