Otolaryngology Coding Alert

Question: How should I code for tympanostomy tube and aural polyp removal under general anesthesia? The otolaryngologist performed both procedures during the same operative session.


Montana Subscriber


Answer: You should bill only the aural polyp excision (69540, Excision aural polyp). The National Correct Coding Initiative (NCCI) 10.3 bundles the tube removal (69424, Ventilating tube removal requiring general anesthesia) into the excision code. Because the physician has to remove the tube to enter the middle ear, the edits make sense.

You could, however, report separate side polyp and tube removal. For instance, if an otolaryngologist performs bilateral tube removal and excises an aural polyp from a patient's left ear, you should report:
  69540-LT
  69424-59-RT.
 
Modifier -59 (Distinct procedural service) informs the payer that the tube removal occurred on a separate site from the excision. The body-side modifiers (-LT, Left side; -RT, Right side) help explain the different sides.