CPT 69420, CPT 69421, CPT 69424, CPT 69433, CPT 69436, CPT 69440, CPT 69450, CPT code 69420, CPT code 69421, CPT code 69424, CPT code 69433, CPT code 69436, CPT code 69440, CPT code 69450, 69420 cpt code, 69421 cpt code, 69424 cpt code, 69433 cpt code, 69436 cpt code, 69440 cpt code, 69450 cpt code

CPT Codes For Incision Procedures On The Middle Ear | Billing Guide

Incision procedures on the middle ear can be reported with CPT 69420, CPT 69421, CPT 69424, CPT 69433, CPT 69436, CPT 69440 and CPT 69450. Below the descriptions and billing guidelines of these codes.

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  1. General Billing Guidelines
  2. CPT 69420
    1. Procedure
    2. Billing Guidelines
  3. CPT 69421
    1. Procedure
    2. Billing Guidelines
  4. CPT 69424
    1. Procedure
    2. Billing Guidelines
  5. CPT 69433
    1. Procedure
    2. Billing Guidelines
  6. CPT 69436
    1. Procedure
    2. Billing Guidelines
  7. CPT 69440
    1. Procedure
    2. Billing Guidelines
  8. CPT 69450
    1. Procedure

1. General Billing Guidelines

A myringotomy can be reported with CPT 69420, CPT 69421 and performed with or without the insertion of tympanostomy tubes.

Report the insertion of tubes under CPT code 69433 or CPT 69436.

CPT 69424 can be reported for the removal of ventilation, myringotomy, or tympanostomy tubes (for example, Shea or Collar button). This procedur may be paid if it is performed under general anesthesia.

However, be aware that the removal of the tubes is considered an integral part of a doctor’s medical care. It is not eligible as a distinct and separate service if this procedure is not performed under general anesthesia.

Report HCPCS code S2225 for a laser–assisted myringotomy. This code may not be accepted by all payers.

Report CPT 69705 and CPT 69706 for balloon dilation of the Eustachian tube via nasopharyngoscopy.

2. CPT 69420

CPT code 69420 is described by the CPT manual as: “Myringotomy including aspiration and/or eustachian tube inflation”

2.1 Procedure

The goal of the 69420 CPT code procedure is to to inflate the eustachian tube (ET) to treat otitis media or ET dysfunction.

With the patient appropriately prepped and using topical anesthesia, the provider treats auditory tube dysfunction or otitis media by making a small cut in the tympanic membrane and dilating the eustachian tube.

He may also aspirate serous fluid or effusion from the tympanic cavity and/or insert a tube through the tympanotomy and inflate the eustachian tube.

2.2 Billing Guidelines

This code is for when the provider performs myringotomy under local or topical anesthesia. Report CPT 69421 for the same procedure with the patient under general anesthesia.

Report CPT 64933 for a tympanostomy and insertion of a ventilation tube under local or topical anesthesia.

Report 64936 for same procedure under general anesthesia.

3. CPT 69421

CPT code 69421 is described by the CPT manual as: “Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia.”

3.1 Procedure

The goal of the 69421 CPT code procedure is to treat ET dysfunction or otitis media by sucking fluid from the middle ear (aspiration). The provider can also inject air through a catheter or tube or tube placed through the tympanotomy with the aim of inflating the eustachian tube.

With the patient appropriately prepped and under general anesthesia, the provider treats auditory tube dysfunction or otitis media by making a small cut in the tympanic membrane and dilating the eustachian tube.

He may also aspirate serous fluid or effusion from the tympanic cavity and/or insert a tube through the tympanotomy and inflate the eustachian tube.

3.2 Billing Guidelines

Report CPT 69421 when the provider performs the same procedure with the patient under general anesthesia.

Report this procedure when a provider performs a myringotomy general anesthesia. Report CPT 69420 foor the same procedure if performed with topical or local or anesthesia.

4. CPT 69424

CPT code 69424 is described by the CPT manual as: “Ventilating tube removal requiring general anesthesia.”

4.1 Procedure

The goal of the 69424 CPT code procedure is to remove a ventilating tube from the ear of a patient.

The patient is prepped and draped in a usual sterile fashion. General anesthesia is induced by an appropriate anesthetic agent.

The provider then pulls out and retracts a previously secured middle ear tube with a grasping device.

The procedure is usually done as an aftercare service following a previously performed related surgery.

4.2 Billing Guidelines

Report CPT 69424 with modifier 50 for bilateral procedures.

Removal of a ventilating tube without general anesthesia is considered part of the E/M service. There is no separate code for reporting its removal.

Do not report code 69424 in conjunction with;

  •  CPT 69205;
  • CPT 69210;
  • CPT 69420;
  • CPT 69421;
  • CPT 69433 to CPT 69676;
  • CPT 69710 to 69745; and
  • CPT 69801 to CPT 69930.

5. CPT 69433

CPT code 69433 is described by the CPT manual as: “Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia.”

5.1 Procedure

The goal of the 69433 CPT code procedure is to make a small opening in the eardrum to insert a ventilating tube.

The patient is prepped and draped in a usual sterile fashion. Local anesthesia is induced by appropriate topical anesthetic agent.

The provider makes a small opening in the eardrum (myringotomy) and secures a delicate tympanostomy tube into the ear drum to provide continuous drainage for the infectious fluid in middle ear and to keep the middle ear aerated while preventing the accumulation of fluid.

5.2 Billing Guidelines

CPT code 69433 is for when a provider performs an office–based tympanostomy using local or topical anesthesia.

Report CPT 69436 instead of this code when the provider performs a tympanostomy in an operating room using general anesthesia.

Do not report CPT 99070 for the tympanostomy tube itself as the supply of the tube is included with the procedure.

Report CPT 69433 with modifier 50 for bilateral procedures.

Report CPT 0583T for tympanostomy requiring insertion of ventilating tube, with iontophoresis, using an automated tube delivery system,

6. CPT 69436

CPT code 69436 is described by the CPT manual as: “Tympanostomy (requiring insertion of ventilating tube), general anesthesia.”

6.1 Procedure

The goal of the 69436 CPT code procedure is to perform tympanostomy for the insertion of a ventilation tube.

The patient is prepped and draped in a usual sterile fashion. General anesthesia is induced by appropriate anesthetic agent.

Myringotomy is performed and a delicate tympanostomy tube is secured into the ear drum to provide continuous drainage route for the infectious fluid in middle ear and to keep the middle ear aerated, while preventing the accumulation of mucus.

6.2 Billing Guidelines

Report CPT code is 69436 for when a physician performs a tympanostomy in an operating room using general anesthesia.

When the provider performs an office–based tympanostomy using local or topical anesthesia, the appropriate code is CPT 69433.

However, code CPT 69436 does not include anesthesia services. The anesthesiologist should bill his own code for that according to the time the patient was anesthetized. The inclusion of “general anesthesia” in the descriptor for CPT 69436 is meant to differentiate it from tympanostomy not requiring general anesthesia. 

Do not report CPT 99070 for the tympanostomy tube itself as the supply of the tube is included with the procedure.

Report modifier 50 with CPT 69436 for bilateral procedures.

7. CPT 69440

CPT code 69440 is described by the CPT manual as: “Middle ear exploration through postauricular or ear canal incision.”

7.1 Procedure

The goal of the 69440 CPT code procedure is to explore the middle ear of a patient via a postauricular or ear canal incision.

The physician performs a diagnostic evaluation (of the middle ear) while adopting an external ear approach to the middle ear and vestibular window.

The technique is employed to rule out certain middle ear abnormalities (for example, cholesteatoma, conductive hearing loss, and tympanic membrane perforation).

7.2 Billing Guidelines

Report CPT 69601 instead of this code for atticotomy.

Do not bill CPT 69440 if the op note doesn’t show middle ear exploration. You are also not allowed to bill this code if there is no medical necessity for doing the exploration when middle ear exploration is shown.

Prove the medical necessity of this procedure. You can get problems with payers if you report the middle ear exploration unnecessarily.

8. CPT 69450

CPT code 69450 is described by the CPT manual as: “Tympanolysis, transcanal.”

8.1 Procedure

The goal of the 69450 CPT code procedure is to improve hearing by destroying scar tissues or adhesions on ear drum or the tympanic membrane.

When the patient is appropriately prepped and anesthetized, the provider uses an operating microscope to visualize the tympanic membrane.

He uses a scalpel to dissect and remove scar tissue from the surface of the tympanic membrane. He then checks for bleeding and uses cautery, if necessary, instills antibiotic drops, and applies a dressing.

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