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Tympanostomy and Myringotomy

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A provider is billing 69420 and 69433 same ear. Isnt 69420 part of 69433 and cant be billed separately.
 

JenniferB7

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Local Chapter Officer
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You are correct. CPT 69420 is included or a component of 69433.

A myringotomy (CPT 69420) involves making an incision into the tympanic membrane and often suctioning fluid from the middle ear. CPT 69433 / 69436 requires an incision into the tympanic membrane for placement of the ear tube and typically involves suctioning of the fluid from the middle ear space prior to the placement of the ear tube. Therefore, CPT 69420 would be considered a component of or inclusive to CPT 69433 / 69436.

If it helps, the NCCI edits located on the CMS website also list a myringotomy (CPT 69420) as a component of CPT 69433 / 69436 for tympanostomy tube placement. https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

Hope that helps!

Jennifer M. Connell, BA, CPC, CENTC, CPCO
 
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