Otolaryngology Coding Alert

Question: I-ve read and been told multiple times not to bill 20926 with 69620 due to the code's description. Otolaryngology Coding Alert 2007 Vol. 9, No. 10 indicates we can bill 20926 with 69620 when the otolaryngologist makes a separate incision. Which is correct? Virginia Subscriber Answer: This is a tricky area because no Correct Coding Initiative (CCI) edit exists on the code pair. But American Academy of Otolaryngology--Head and Neck Surgery/Foundation (AAO-HNS) physician advisers suggest that harvesting the graft is part of myringoplasty code 69620 (Myringoplasty [surgery confined to drumhead and donor area]). They indicate 69620 is different from the rest of the otology codes because the code's descriptor defines myringoplasty as confined to the drumhead and donor area. Based on convention, the myringoplasty includes the graft. Therefore, they recommend that you not bill 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]) in addition to 69620, regardless of separate incisions or different sites (meaning not the myringoplasty ear). Remember: Code 69620's 20926 inclusion is the exception. The second rationale you mention -- that a graft is separately reportable when the otolaryngologist obtains cartilage, fascia or other tissue through a separate incision -- does apply to 69631 (Tympanoplasty without mastoidectomy [including canalplasty, atticotomy and/or middle ear surgery], initial or revision; without ossicular chain reconstruction). You could bill 20926 or 21235 (Graft; ear cartilage, autogenous, to nose or ear [includes obtaining graft]) in addition to 69631 when the graft involves a separate incision from the tympanoplasty.