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Otolaryngology Coding Alert

Reader Question:
Myringotomy or Tymp: Look for PE Tube Placement

Question: What is the difference between 69421 and 69436? Ohio Subscriber Answer: Code 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia) is for a myringotomy with insertion of a ventilating or pressure equalizing (PE) tube, but 69421 (Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia) describes a myringotomy with no tube placement. CPT uses the term -tympanostomy- to represent a myringotomy with tubes: 69436. Codes 69421 and 69436 are similar in two aspects. Both codes involve an incision into the tympanic membrane or ear drum (myringoplasty) and contain the word -tube- in their descriptors. In 69421, the surgeon may inflate the patient's eustachian tube, the internal channel between the middle ear and the nasopharynx. But in 69436, the surgeon inserts a tiny drainage tube to relieve chronic ear infections. Thus, the key difference is whether the surgeon places a tube (artificial) (69436) or not (69421). Test your 69421 and 69436 coding skills with this note: -Procedure: Bilateral myringotomy with PE tube placement. -I evaluated the right ear, removed cerumen and performed anterior-inferior myringotomy. I suctioned mucoid fluid from the middle ear space and inserted a collar button tube. -I turned my attention to the left ear and performed anterior-inferior myringotomy. I suctioned mucoid fluid from the middle ear space and inserted a collar button tube.- Although your otolaryngologist refers to these procedures as a myringotomy, he is really performing -- in CPT terms -- tympanostomy. Because the surgeon places PE tubes, you should report 69436 bilaterally (modifier 50), instead of 69421-50. Show your physician the confusion that using -myringotomy- instead of -tympanostomy- causes and encourage him to use the coding nomenclature, rather than the clinical term.


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