Use 69610-RT for More Complex Procedure

In a particular situation, my physician evaluated the patient's right ear and cleared the canal of all cerumen. The tympanic membrane was visualized and had retained a tube. The physician removed a tube in the anterior superior aspect of the eardrum with a Rosen needle. He removed an epithelial callus around the tube site with a Rosen needle. Also Ciprodex was applied. After this, a paper patch was then placed in an overlay technique and positioned using the operative microscope. Post this the physician went to the left ear and removed some dry debris. He removed an extruded tube and there was no perforation in situ. He debrided the canal and applied Ciprodex. So how do you code for this situation?

Well, first you should code the more complex procedure with 69610-RT (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch; Right side).

Stay away from these options: you can't code for the binocular microscope (92504) as it's a separate procedure and inclusive with any other ear procedure carried out. Likewise, the removal of impacted cerumen (69610) is also a separate procedure, and insurers consider it inclusive with any other ear procedure. What's more, if the carried out this service in the operating room, you can't report 69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) as even though the physician used the operating microscope, coding 69990 requires the use of microsurgical technique. These procedures do not have any evidence of microsurgery.

Secondly, report 69424-59-LT if the physician carried out this procedure in the operating room under general anesthesia. If the doctor carried out this service under local anesthesia in the OR or for that matter in the office, you can report 92504-59-LT for the use of the binocular microscope as you won't find any code for tube removal when the physician does not use general anesthesia.

Typically, if an otologic procedure needs a transcanal or endaural approach with incision of the tympanic membrane and access through the middle ear and tympanic membrane procedures, you shouldn't report it separately. But then your physician carried out these services on two ears and should be paid for them as separate procedures.

Here's what your claim should look like: 69610-RT, 69424-59-LT or 92504-59-LT depending on the type of anesthesia the physician used.

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