Procedure Practice 06/15/99 - Feature Article 06/15/99
   

Procedure Practice 06/15/99:
Coding Recommendations

  
Listed below are the ICD-9-CM diagnosis and procedure codes as well as the CPT-4 procedure codes that we think properly classify the treatment described. Please note that modifiers, used only for physician billing purposes, have not been assigned to the CPT-4 codes. If you disagree with our suggestions or have other comments, please send an e-mail to codingedge@lagunamedsys.com.
   

Suggested Codes and Rationale
   

ICD-9-Diagnosis Codes

The patient had chronic serous otitis media. In the Index to Diseases locate the entry for otitis and the subentry for media, serous. The coder is directed to 381.10. Upon reading the code description in the Tabular List, we find that 381.10 is the correct diagnosis code: Chronic serous otitis media, simple or unspecified.
  

ICD-9-CM Procedure Codes

Bilateral myringotomies with ventilating tubes were performed. In the Index to Procedures we find the code 20.01 under the entry for "Myringotomy with insertion of tube or drainage device (button) (grommet)." The code description verifies that 20.01 is the correct choice: Myringotomy with insertion of tube. Because the procedure was done bilaterally, the code must be reported twice.
  

CPT-4 Procedure Codes

The Index entry for "Myringotomy" refers to 69420 and 69421. Review of these codes shows that neither one describes the insertion of ventilating tubes. The coder must search under the synonymous term tympanostomy. The index entry for "Tympanostomy" lists two codes: 69433 and 69436. Since general anesthesia was used in this case, the correct code is 69436, Tympanostomy (requiring insertion of ventilating tube), general anesthesia. The modifier -50 must be applied to this code to correctly identify the surgery as a bilateral procedure. In addition, the new code 69990 is used to indicate that the surgery required the use of an operating microscope.

Procedure Practice 06/15/99 - Feature Article 06/15/99