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removal of myringotomy tube with paper patch myringoplasty

Bill Posted Tue 06th of May, 2014 10:51:23 AM

Can you please advise on the following report: "The inferior myringotomy tube was removed with an Alligator forceps. A small piece of cigarette paper was placed over the perforation. Bacitracin ointment was used to coat the paper patch and a cotton ball was used to dress the meatus." This surgeon stated he did a paper patch myringoplasty in addition to removal of tube...do you think his dictation supports procedure code "69620" or is there a better code? I thought "69624" would cover removal of tube. Should I bill "69624" only? thank you

SuperCoder Answered Tue 06th of May, 2014 16:51:49 PM

This is 69610 only.

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]).

CMS reasons that the otolaryngologist must remove the tube prior to patching the ear drum, and thus makes 69424 a component of 69610. Therefore, you should code a tube removal with ear drum patch as 69610.

Bill Posted Wed 07th of May, 2014 08:07:07 AM

That makes sense! Thank you so much

SuperCoder Answered Wed 07th of May, 2014 12:13:41 PM

You are welcome!

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