THE CODING EDGE® ARCHIVES

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Procedure Practice 07/15/99 - Feature Article 07/15/99
   

Procedure Practice 07/15/99:
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 has chronic suppurative otitis media with tympanic membrane perforation. In the Index to Diseases, locate the entry for "Otitis" and the subcategory for "Otitis media, chronic, benign suppurative (with anterior perforation of ear drum)." The code 382.1 is listed. The Tabular List verifies that 382.1 is the correct code for this condition: Chronic tubotympanic suppurative otitis media: Benign chronic suppurative otitis media; chronic tubotympanic disease with anterior perforation of ear drum.
  

ICD-9-CM Procedure Codes

The surgeon performed a tympanoplasty with fascial graft and a simple mastoidectomy. The incus was also excised during this procedure. The Index to Procedures entry for "Tympanoplasty (type I) (with graft)" directs the coder to 19.4. The description in the Tabular List verifies that 19.4 is the correct code: Myringotomy, epitympanic, type I; myringoplasty by cauterization, graft; Tympanoplasty (type I). The correct code for simple mastoidectomy, 20.41, is found under the Index to Procedures entry for "Mastoidectomy, simple." The description in the Tabular List verifies that this code is correct: Mastoidectomy, simple mastoidectomy. It is not necessary to assign an additional procedure code for the incus excision. Under the Index to Procedures main entry "Incudectomy" the subentry "with tympanoplasty" directs the coder to "See tympanoplasty."
  

CPT-4 Procedure Codes

The CPT Index contains numerous subheadings under the main entry for Tympanoplasty. A careful review of the code selections directs the coder to 69643, "Tympanoplasty with mastoidectomy with intact or reconstructed wall." The code description verifies that 69643 correctly identifies the procedure performed: Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction. The surgeon indicates that an operating microscope was used. In 1999, a new CPT code was created to identify procedures in which an operating microscope is employed. Assign 69990, Use of operating microscope (List separately in addition to code for primary procedure), as a secondary code to reflect the use of the microscope during surgery.
  

Procedure Practice 07/15/99 - Feature Article 07/15/99

Bibliography - References:
1999 Coders Desk Reference, Medicode, Salt Lake City, UT
CPT 1999 Professional Edition, American Medical Association, Chicago, IL
St. Anthony’s Illustrated ICD-9-CM Code Book, St. Anthony Publishers, Reston, VA		 Notice: This part of our web site was prepared to assist in understanding and maintaining good coding skills. For proper use of this feature, reference must be made to official coding guidelines when necessary. The information here presented is only to be used as a supplement to those guidelines. Laguna Medical Systems, Inc., makes no representations or guarantees as to amounts that will be paid by Medicare or other third party payers.

 

Please be aware that the Coding Edge® Archive pages are NOT retroactively updated
to reflect possible coding rules and regulation changes made after the publishing date.