Some otolaryngologists have reported using 69200 (removal of foreign body from external auditory canal; without general anesthesia) or 69205 (with general anesthesia) to get paid for removing PE tubes long after the global period for the original tympanostomy has ended. The American Academy of Otolaryngology-Head and Neck Surgeons and
otolaryngology coding experts agree that billing for the removal of tubes this way is inappropriate.
The tubes that were inserted during a tympanostomy (69436, tympanostomy [requiring insertion of ventilating tube], general anesthesia) or 69433 (tympanostomy [requiring insertion of ventilating tube], local or topical anesthesia) sometimes need to be removed if they do not come out on their own. The otolaryngologist cannot bill separately for taking them out, however, because the removal regardless of how long after it occurs is considered part of the global period if it is performed by the same physician, even though 69436 has only 10 global days.
CPT guidelines currently allow billing for removal of tubes only if the tubes were inserted by another physician. This procedure is coded 69424 (ventilating tube removal when originally inserted by another physician).
Note: A physician operating under the same tax identification number as the doctor who performed the original tympanostomy also cannot bill 69424.
The wording of 69424 implicitly clarifies CPTs position even though the tympanostomy code does not refer to removal of tubes, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist in Lakewood, N.J.
Foreign Body Removal Code Is Inappropriate
Many otolaryngologists believe that including tube removal in the fee of the original tympanostomy (often performed months or years later) is unfair and goes against CPT conventions (for example, even related services during the global period of a primary procedure often are paid if the correct modifier is attached). Because code 69424 explicitly rules out tube removal by the same physician who inserted the tubes, some otolaryngologists, in their frustration, are using the removal of foreign body codes to gain reimbursement and some carriers are paying for such claims. That, however, does not mean it is correct.
PE tube removal by the same physician cannot be billed as a foreign body removal under any circumstance, says Eileen M. Giaimo, assistant director of socioeconomic affairs with the American Academy of Otolaryngology-Head and Neck Surgeons. It is not a foreign body. While sympathizing with the otolaryngologists on this issue, coding experts warn that even if a carrier pays for the foreign body removal, that does not mean it would stand up in the event of an audit.
Practice Correct Coding
There are several reimbursement strategies, however, depending on the circumstances and the procedures performed, that, when appropriately billed, could compensate otolaryngologists for ancillary work, such as [...]
