Otolaryngology Coding Alert

Question: A non-Medicare patient was seen on Aug. 11, 2006, for a mastoidectomy and a tympanostomy in the hospital. When the patient came back in the office to see the otolaryngologist on Sept. 08, 2006, the patient had a blocked PE tube that the doctor removed. He suctioned the blood clot and fluid and replaced the tube. Should I charge for putting the tube in again or consider the procedure as a follow-up?


North Carolina Subscriber
Answer: Since the patient is not a Medicare beneficiary and the otolaryngologist replaced the tube in the office as you state in the question, you should bill the placement of the tube using 69433 (Tympanostomy [requiring insertion of ventilating tube], local or topical anesthesia) appended with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period).

The modifier is appropriate because the tympanostomy is unrelated to the postoperative period (90 days per the National Physician Fee Schedule) that is in effect for the mastoidectomy (such as 69501, Transmastoid antrotomy [simple mastoidectomy]).

For the ICD-9 code, use the complication of the tube, such as 996.74 (Other complications of internal [biological] [synthetic] prosthetic device, implant, and graft; due to other vascular device, implant, and graft).

Reminder: Do not bill the removal (69424, Ventilating tube removal requiring general anesthesia). The service is included (bundled) in the initial placement (such as 69436, Tympanostomy [requiring insertion of ventilating tube], general anesthesia). You Be the Coder and Reader Questions were reviewed by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.