Otolaryngology Coding Alert

Answer Five Crucial Questions for Tympanic Repair To Determine Code Selection


- Published on Mon, Oct 01, 2001

Several factors make the selection of a tympanic repair code difficult. Probably the most important is that there are many tympanic repair procedures, from the relatively simple "paper patch" repair to radical tympanoplasty and mastoidectomy with ossicular chain reconstruction.
 
Tympanic perforations can be caused by trauma, middle-ear infection, cholesteatoma or other disease. Fifteen codes in the "Repair" subsection of the 69000 series (auditory section) of the CPT manual may be used to report this continuum of tympanic repair procedures, and selecting the correct code can be overwhelming.
 
The coder may lack the knowledge of medical and CPT terminology required to understand how the codes differ from each other. The otolaryngologist may be unaware that the codes do not correspond with the tympanoplasty categories (type I through type V) that he or she is familiar with. For example, mastoidectomy, a major factor in tympanoplasty coding, figures very little in determining the clinical type of tympanoplasty performed.
 
The difficulties with the codes may be further exacerbated because some of the descriptors do not necessarily match what the otolaryngologist performs.
 
"This is a classic example of the importance of using CPT rather than clinical terminology at the top of the operative report," says Randa Blackwell, coding and reimbursement specialist with the department of otolaryngology at the University of Maryland in Baltimore. She says new, inexperienced coders are unlikely to know the clinical difference between mastoidectomy and mastoidotomy, as well as the clinical subtleties that differentiate radical from modified radical, or a tympanoplasty with mastoidectomy from a tympanoplasty/mastoidectomy with reconstructed wall.
 
However, if the otolaryngologist's documentation provides clear answers to the following questions, it may be possible to zero in quickly on the correct code.
No. 1: Was the Surgery Performed in the Office or the OR?
The simplest tympanic repair is often referred to as a paper patch and is reported with 69610 (tympanic membrane repair, with or without site preparation or perforation for closure, with or without patch). This procedure involves patching a small puncture of the eardrum with a cigarette-type paper and is typically performed in the otolaryngologist's office. Three or four applications of a patch may be needed before the perforation closes completely.
 
The paper-patch technique sometimes fails, and even if the patch is placed correctly, it does not always provide prompt or adequate closure of the tympanic membrane perforation. In such cases, the otolaryngologist may need to perform myringoplasty, which involves using a fat or soft-tissue graft (usually temporalis fascia) to repair the perforation. Unlike the paper patch, myringoplasty is typically performed in the operating room (OR) and is coded 69620 (myringoplasty [surgery confined to drumhead and donor area]).
 
Note: For a discussion on billing tympanic repair grafts, see sidebar on page [...]

Otolaryngology Coding Alert
Issue - Oct, 2001
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