Otolaryngology Coding Alert

Question: Part of an operative note reads: Operation: "Bilateral myringotomies with Armstrong grommet tubes, Adenoidectomy, and Tonsillectomy." Consent: "The procedure, benefits and risks were discussed in detail preoperatively. The 3-year-old patient's parents agreed to proceed after all questions were answered." Technique: "- the right external auditory canal was cleaned out under the microscope. Serous fluid was aspirated from the middle ear space. An Armstrong grommet tube was placed down through the incision and rotated into place. The opposite ear was then cleaned out under the microscope. Serous fluid was aspirated from the middle ear space. An Armstrong grommet was aspirated from the middle ear space. An Armstrong grommet was placed down through the incision and rotated into place - The adenoid fossa was visualized with the mirror. The adenoids were removed using the microdebrider. The Bovie electrocautery was used to make an incision in the right anterior tonsillar pillar, and the plane was developed between the tonsil and the musculature. The tonsil was completely dissected out of this plane, preserving both the anterior and posterior tonsillar pillars -" The last two sentences are repeated describing the right side. How many procedure codes should I report? Georgia Subscriber Answer: You should report two CPT codes, provided the insurer accepts modifier 50 (Bilateral procedure) on one line. Here's the breakdown of the codeable procedures. The whole ear section should be reported as a bilateral tympanostomy with 69436-50 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia). Code 69436 represents a myringotomy with tube insertion, which CPT refers to as a tympanostomy. Include the removal of the grommet from the left ear in the tympanostomy. The surgeon cannot perform the tympanostomy without removing the tube. The rest of the abbreviated operative note falls under tonsillectomy with adenoidectomy: 42820 (Tonsillectomy and adenoidectomy; younger than age 12). This code is inherently bilateral, meaning it requires removing both tonsils with the adenoids as the surgeon indicates with "the adenoids were removed using the microdebrider" and "the tonsil was completely dissected" on first the right and then the left side. Watch out: Make sure you check that the insurer pays the claim's bilateral portion at 150 percent and not 100. For instance, using the 2008 Medicare Physician Fee Schedule, you would be paid appoximately the following for a claim reading: - 42820 $288 at 100 percent or $288 - 69436-50 ($163 at 150 percent) times 50 percent or $122 Total: $410.