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Question Ear procedure bundled codes?

Manders21

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Auburn Hills, MI
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Can anyone tell me what the rules are for coding excision of cholesteatoma/polyp with an ear procedure such as a myringoplasty? There are no ncci edits with cpt code 69610 and 69540. But since it is happening in the same ear, I wasn't sure if an excision of a polyp would be included in the myringoplasty procedure. And same for when it is a removal for a cholesteatoma (cpt code 69145). Since there are no ncci edits, it is ok to use either 69540 or 69145 with cpt code 69610? or are codes 69540 and 69145 bundled with 69610? Below I have an op report for a gelfoam myringoplasty with excision of aural polyp.

Procedure: Bilateral gelfoam myringoplasty with bilateral tympanostomy tube removal, bilateral excision of aural polyp, and bilateral ear wash

Details: The patient was seen in prop. He was brought back to the OR suite. The patient underwent mask sedation. Once appropriately sedated, we did examine the left external auditory canal and tympanic membrane. There was significant drainage debris and there was aural polyp. Next, using a 7 French suction and cup forceps, we did remove this from the external auditory canal. We did identify retained tympanostomy tube which we then removed as well. Then using a myringotomy pick, I did freshen and removed the edges of the tympanic membrane for preparation to stimulate growth. We then rinsed the ear with both Betadine and acetic acid. I then placed the Gelfoam patch recreating the eardrum in a myringoplasty fashion on the left side. We then placed bacitracin ointment to hold such patch in place. Attention was turned to the right ear. The procedure was carried out in the same fashion but the tympanostomy tube was partially in the tympanic membrane. There was an associated perforation there. The aural polyp was removed. The ear was washed and then the gelfoam was placed after the edges were freshened of the tympanic membrane perforation and all squamous debris was removed. Once this was done, a gelfoam patch was put in place and then the ear was filled with bacitracin ointment to hold such patch.
 

b.cobuzzi

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Based on your operative note, the myringoplasty is being performed because of the tubes that had been in the ears and were now removed. Since the closure of the tympanum is not closing access for the aural polyp, I would consider it ok to code 69610. But if the closure of the tympanum is being done to close the access to the polyp or cholesteatoma, I would not code it separately.
 

Manders21

Guru
Messages
102
Location
Auburn Hills, MI
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Based on your operative note, the myringoplasty is being performed because of the tubes that had been in the ears and were now removed. Since the closure of the tympanum is not closing access for the aural polyp, I would consider it ok to code 69610. But if the closure of the tympanum is being done to close the access to the polyp or cholesteatoma, I would not code it separately.
Thank you!
 
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