Otolaryngology Coding Alert

Question: I receive frequent denials for 69990 (ear examination with operating microscope [OM]) with 69436 (myringotomy and tube insertion). I should report 69990 in addition to the code for the primary procedure, according to the 2004 CPT manual. CPT doesn't list 69436 as a procedure in which use of the OM is an inclusive component. Any suggestions?

Hawaii Subscriber Answer: You should not bill +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) in addition to 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia). The National Correct Coding Initiative edits bundle 69990 into 69436.
 
You are correct that CPT doesn't list 69436 as a procedure in which use of the OM is an inclusive component. The problem is, however, that 69990 no longer refers to use of the OM as you indicate.
 
CPT 2002 revised 69990's definition from "use of operating microscope" to "microsurgical techniques, requiring use of operating microscope." That change means you should report 69990 only when you perform a procedure that requires microsurgery or microdissection.
 
When you perform a tympanostomy, you use the OM as a magnification or illumination tool to guide or facilitate tube placement and excision. You don't use it to perform microdissection. Therefore, you shouldn't code 69990 in addition to 69436.
 
In fact, 69990 contains more relative value units (RVUs) than 69436. It would not be appropriate to receive more money for an add-on procedure than for the primary procedure.