Otolaryngology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: An otolaryngologist inserts pressure equalization (PE) tubes; six months later the same physician removes the tubes. I have heard many consultants say that when this occurs, the otolaryn-gologist cannot bill for the removal of the tubes, but where does it say so in writing? After all, the codes for tube placement (69433*, Tympanostomy [requiring insertion of ventilating tube], local or topical anesthesia]; and 69436, Tympanostomy [requiring insertion of ventilating tube], general anesthesia) do not state, "with tube insertion and removal." Mississippi Subscriber   Answer: Neither 69433 nor 69436 states that the insertion of the tubes also includes the removal. But CPT includes a code for the removal of tubes (69424), which clearly states, "ventilating tube removal when originally inserted by another physician." Because the same physician inserted and removed the tubes, the removal cannot be billed. If the otolaryngologist performed and documented an E/M service (for example, an established patient visit) at the same time as the removal of the tubes, an appropriate-level code for the placement of the tubes (99211-99215) may be reported. And the removal of the tubes may, in some cases, boost the level of medical decision-making, which in turn may boost the level of the established patient visit reported.