Revenue Cycle Insider

Question: I am trying to find the correct way to code removal of tympanostomy (PE) tubes. The only code I can find is 69424, but that code references using anesthesia, which our otolaryngologist did not do. What should I do?

Connecticut Subscriber

Answer: You are correct in saying you would only use 69424 (Ventilating tube removal requiring general anesthesia) in the operating room and if the surgeon performed the PE tube removal under general anesthesia.

Instead, you should use an appropriate low-level office/outpatient evaluation and management (E/M) code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) for PE tube removals when they occur in your office.

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) also offers the following advice about removing PE tubes:

• You should never report 69200 (Removal foreign body from external auditory canal; without general anesthesia) for a PE tube removal. That’s because “Removal of tympanostomy tubes in the office setting does not meet the criteria of a foreign body removal,” as AAO-HNS notes. Per the CPT^Ò surgery guidelines definitions, tympanostomy tubes are regarded as implants, or objects “placed by a physician for any diagnostic or therapeutic purpose,” whereas a foreign body is “is any object that is unintentionally placed; for example, swallowing a penny or glass lodged in soft tissue after an accident.”
• You can, however, report 92504 (Binocular microscopy (separate diagnostic procedure)) if your provider has to use microscopy to aid in the removal, as the descriptor tells you can report the microscopy separately.
• Finally, for tube removal “on the same date of service from the same ear for which a repair is performed,” AAO-HNS tells coders to report only 69610 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch). “This is because removal of the tube is part of the repair service; this is reflected in the higher value of the repair,” according to AAO-HNS.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC