Come to Equal Terms When Billing for Postop Tube Removal
Published on Thu Aug 01, 2002
" When you bill postoperative tympanostomy care for the same otolaryngologist who placed the tubes, you must pay attention to opportunities to capture the physician's full work, but not open the door to fraudulent coding errors. Tympanostomy Encompasses Same-Physician Removal When an otolaryngologist places a pressure equalizing (PE) tube, you should report the procedure with one of two codes, based on the anesthesia used:
69433* Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia
69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia. Although neither code specifies placement and removal, both codes imply placement and removal. The only CPT code that explicitly refers to tube removal is 69424 ventilating tube removal when originally inserted by another physician"" (emphasis added). In 69424's definition" CPT implies that when the same physician who placed the tubes removes them the tube placement (69433 or 69436) includes the removal. Despite low reimbursement for tube placement "subsequent removal is built into the relative value units and therefore should not be billed " says Beth Thomsen CPC ENT department billing coordinator for Associated Physicians of Medical College of Ohio in Toledo. Even if a physician removes the tubes years after he placed them 69424 should not be billed.
"This applies not only to the physician who placed the tubes and the other physicians in the same group practice but also to the on-call physician who when treating another's patients is required to bill those patients as established " Thomsen explains. Follow-Up Warrants an E/M Service After 69436's 10-day global period expires you should report follow-up visits with the appropriate established patient office visit code (99211-99215). To understand how to code follow-up visits let's follow a hypothetical tubes patient. Suppose an otolaryngologist treats a 3-year-old child who has chronic otitis media (382.9). The physician decides to place ventilating tubes in the girl's ears to reduce the recurrent infections. Because of the child's age the doctor performs tympanostomy under general anesthesia. For the first ear the physician reports 69436. For the second ear she assigns 69436-50 (Bilateral procedure). Note: Although Medicare and some private payers require using one line to report 69436 and 69436-50 others prefer two lines. If the child returns in four to six months for a checkup use 99211-99215 to report the visit. Use the original otitis media diagnosis to explain the E/M visits. Code 382.9 is still appropriate because it explains why the physician is seeing the patient and why she has tubes in her ears. Microscopy Includes Examination If the otolaryngologist inspects the tubes and the tympanic membrane using the binocular microscope during one of these visits with the same 3-year-old assign either 92504 (Binocular microscopy [separate diagnostic procedure]) or 99211-99215 (Established [...]
