Anesthesia Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Our anesthesiologists often assist when children return to our hospital to have tubes removed from their ears. We code this with either CPT 69205 (removal foreign body from external auditory canal; with general anesthesia) or CPT 69610 (tympanic membrane repair, with or without site preparation or perforation for closure, with or without patch) for a paper patch -- if we have documentation to support it, that is, noting  the patient patch to tympanic membrane placement. What is the best supporting diagnosis for these cases?

South Carolina Subscriber
  Answer: Several options are appropriate. Coding with 996.59 (mechanical complications of other specified prosthetic device, implant, and graft; due to other implant and internal device, not elsewhere classified) and including the reason for tubes being placed is accepted by many carriers, including some Medicaid carriers. Use 931 (foreign body in ear) if the retained tubes are in the external rather than the middle ear, or 385.83 (other disorders of middle ear and mastoid; retained foreign body of middle ear) if the tubes are in the middle ear. V58.49 (encounter for other and unspecified procedures and aftercare; other specified aftercare following surgery) is also appropriate. This is not as specific as the other diagnosis codes but could be used as a secondary diagnosis to others such as 931 or 385.83. The code choice depends on whether there was a complication or if the tubes did their job and are ready for removal. The tubes will generally fall out on their own, so anesthesia is not usually required for removal.