Vol. 14 •Issue 12 • Page 18
Coding Corner
Coding Procedures of the Auditory System
Case Study 1
Preoperative Diagnosis: Adhesive otitis, left ear
Postoperative Diagnosis: Adhesive otitis, left ear
Procedure.Performed: Myringotomy and tympanotomy tube, left ear; examination under anesthesia of right ear
Anesthesia: General
Indication for Procedure: This child presents with persistent adhesive otitis of the left ear for replacement of ventilating tube.
Operative Technique: After the induction of adequate general anesthesia, the patient in the supine position, the eyes were protected and the left ear was visualized under the operating microscope.
The canal was cleaned of debris. An anterior inferior myringotomy was performed. Fluid and negative pressure was noted. A modified Richards T-tube was placed without difficulty. Vasocidin was instilled in the canal. In a like fashion, the right ear was visualized with the operating microscope. The canal was cleaned of debris. A T-tube was seen in place and patent. At this point, the procedure was terminated.
The patient was awakened in the operating room and was brought to the recovery room in stable condition without any blood loss.
ICD-9-CM Code Assignments
Preoperative Diagnosis: Adhesive otitis,
left ear
385.10 Adhesive middle ear disease, unspecified as to involvement
Postoperative Diagnosis: Adhesive otitis,
left ear
385.10 Adhesive middle ear disease, unspecified as to involvement
CPT Code Assignments
The surgeon examined the left ear and found debris, fluid and negative pressure. A tympanostomy tube was inserted into the left ear with the use of the operating microscope under general anesthesia. While the patient was under general anesthesia, the right ear was examined, and the T-tube in place was found to be patent.
To assign the code for the T-tube placement, refer to the term Tympanostomy in the CPT manual index. Following this term, codes 69433-69436 are listed. After you check the descriptions of these codes, you will see that 69436 is the correct code. To communicate that the tube was placed in the left ear canal, assign modifier LT (left side) to the facility code.
To code the examination of the right ear, refer to the terms Otolaryngology, Diagnostic and Exam Under Anesthesia 92502. The description of this code confirms that it is the appropriate choice. To communicate that the procedure on the right ear was a separate procedure from the tube insertion of the left ear, you would assign modifier 59 (distinct procedural service) to both the facility code and professional code assigned. Also assign modifier RT (right side) to the facility code to indicate that it was the right ear.
Facility Code Assignments:
69436-LT Tympanostomy (requiring insertion of ventilation tube), general anesthesia
92502- Otolaryngologic examination
59-RT under general anesthesia
Professional Code Assignments:
69436 Tympanostomy (requiring
insertion of ventilation tube),
general anesthesia
92502-59 Otolaryngologic examination under general anesthesia
Note: The use of the operating microscope (69990) is not reported separately as the CCI edits state the operating microscope is a component of CPT code 69436 and is never allowed by Medicare.
Case Study 2
Preoperative Diagnosis: Meniere’s disease
Postoperative Diagnosis: Meniere’s disease
Procedure Performed: Gentamycin ablation, left ear
Anesthesia: Local with 1% Xylocaine with Epinephrine and 4% topical Xylocaine supplemented by IV sedation
Operative Technique: With the patient in the supine position, the left ear was prepped in a sterile manner with Betadine. The operating microscope was brought into the field, and the posterior canal skin was infiltrated with 1% Xylocaine with Epinephrine. The tympanic membrane was then palpated and found to be anesthetized.
A posterior tympano-meatal flap was elevated and reflected forward in a routine manner. After the middle ear was entered, a pledget of cotton with 4% Xylocaine was placed. The round window was readily apparent, and a small pledget of gel foam soaked in Gentamycin solution was placed in the round window notch. The middle ear was then filled with Gentamycin 40 mg per cc. The tympano-meatal flap was suctioned back into position and secured with a pledget of pressed dry gel foam. The external ear canal was then filled with Polysporin ointment.
The patient tolerated the procedure well and left the operating room in good condition.
ICD-9-CM Code Assignments
Preoperative Diagnosis: Meniere’s disease
386.00 Meniere’s disease, unspecified
Postoperative Diagnosis: Meniere’s disease
386.00 Meniere’s disease, unspecified
CPT Code Assignment
The ablation of the inner ear was done with a Gentamycin solution placed on a pledget and then instilled into the ear. Currently, there is not a specific CPT code for this procedure, as this was a perfusion of drugs. Because there is no code, you will refer to the term Unlisted Services and Procedures in the CPT manual index. Under this entry, look for the term Ear and then Inner É 69949.
After reading the code description, you will see that this is the correct code. It should be assigned as the facility and professional codes and does not require a modifier.
69949 Unlisted procedure, inner ear
Note: As above, the use of the operating microscope (69990) is not reported separately as the CCI edits state the operating microscope is a global component of the larger procedure, and is never allowed by Medicare.
Susan Howe is a senior health care consultant with Medical Learning Inc. (MedLearn®), St. Paul, MN.
