Otolaryngology Coding Alert

Question: How should I code excision of a cholesteatoma of the external auditory canal (EAC)?

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Answer: Dorlands Medical Dictionary defines a cholesteatoma as a cyst-like mass or benign tumor with a lining of stratified squamous epithelium, usually of keratinizing type, filled with desquamating debris frequently including cholesterol. This means an EAC cholesteatoma can be considered a lesion of the external ear. CPT includes three codes for excision of an external ear lesion: 69145, 69150 and 69155. If the cholesteatoma is small and completely situated in the subcutaneous tissue of the EAC, 69145 should be reported. If it is large and requires radical excision, use 69150. If a neck dissection is also performed, 69155 should be reported. In such cases, a separate neck dissection code (cervical lymphadenectomy codes 38720 or 38724) should not be billed.
 
Note: Radical codes such as 69150 and 69155 may be used for nonmalignant lesions like cholesteatomas if the procedure is as extensive as might be necessary for a malignant tumor (removal of other tissue, including bone, muscle, etc.).