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Otolaryngology Coding Alert

READER QUESTIONS:

CCI Bundles PE Tube with Tympanoplasty

Published on Sun Mar 01, 2009

Question: If the surgeon performs a tympanoplasty without mastoidectomy or ossicular chain reconstruction (69631) and pressure-equalization tube placement (69436) on the same site, can the tube be reported separately? Massachusetts Subscriber Answer: No, not if your ENT places the tube at the same encounter as the tympanoplasty. According to Correct Coding Initiative (CCI) edits, 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia) is a component of code 69631 (Tympanoplasty without mastoidectomy [including canalplasty, atticotomy and/or middle ear surgery], initial or revision; without ossicular chain reconstruction). CCI does allow you to differentiate between the two procedures in certain circumstances. For instance, if your ENT performed the tympanoplasty on the left ear and placed a PE tube in the right ear, youd code 69631-LT and 69436-59-RT. Modifier 59 (Distinct procedural service) alerts the payer you have a code thats normally bundled, but shouldnt be in this case, as it was performed [...]
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