Otolaryngology Coding Alert

Question: An otolaryngologist performed a myringotomy with tubes under general anesthesia. Should I report 69421 for the procedure?

Florida Subscriber Answer: You should use 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia). What CPT refers to as "tympanostomy" is actually a myringotomy with tubes.

To avoid improper coding, you should encourage your otolaryngologist to use CPT nomenclature rather than the clinical term. Show your surgeon the confusion that dictating "myringotomy with tubes" creates. Based on an operative note that states "myringotomy with tubes," you look up "myringotomy." The CPT index directs you to 69420* (Myringotomy including aspiration and/or eustachian tube inflation) and 69421* (... requiring general anesthesia). Both 69420 and 69421 describe tubes (eustachian tubes, not the ventilating tubes that the surgeon inserted, but you don't know that), so you incorrectly select 69421. Of course, 69420-69421 refer to inflating the patient's auditory and/or eustachian tube, the internal channel between the middle ear and the nasopharynx. But the surgeon, in your example, actually inserts a ventilating tube, an artificial tube that provides drainage to help reduce middle-ear infections, into the patient's eardrum. These ventilating tubes imply 69433* (Tympanostomy [requiring insertion of ventilating tube], local or topical anesthesia) or 69436. Both codes include incising the eardrum.