The major challenge that every physician faces while running a healthcare practice is medical billing. Why? Because medical billing requires CPT codes that describe the services healthcare providers perform. However, physicians often use the wrong CPT codes. Due to this confusion, payouts get delayed or claims are denied straightaway.
For this reason, we started our series on CPT codes, giving you all the information you may need for their correct usage and to file clean claims. Today, the code that we have selected is CPT code 69433. So, let’s explore its descriptor, clinical applications, suitable modifiers, and billing guidelines.
CPT Code 69433 – Description
CPT code 69433 refers to a process called “Tympanostomy.” It is a process where the physician makes a small incision in the eardrum to insert a ventilation tube. The entire procedure is performed under topical or local anesthesia to minimize pain and discomfort.
Tympanostomy is also called an ear surgery. During this process, the physician initially numbs the eardrum using local or topical anesthesia to minimize the discomfort. He then makes a small incision in the eardrum to insert a ventilation tube (PE tube or grommet) and drain or suction out the trapped fluid.
This process is usually performed to treat the accumulation of ear fluid in the middle ear, equalize pressure, or cure recurring ear infections. It improves hearing, reduces the frequency and intensity of ear infections, and re-establishes appropriate ear ventilation.
Scenarios Where CPT Code 69433 is Applicable
You may apply CPT code 69433 in the following scenarios.
Middle Ear Infection (Otitis Media)
Middle ear infections, or otitis media, are more common in children. Research indicates that between 80 and 90% of children have this problem. But it can also happen to grown-ups.
So let’s imagine that a man in his mid-twenties visits the clinic with excruciating ear pain combined with a fever. The physician examines his ear and finds swelling around the eustachian tube. This, he suspects, is causing fluid buildup in the middle ear, leading to symptoms consistent with otitis media. He administers local anesthesia to prevent pain and performs tympanostomy for 10 minutes to treat the condition. Later, CPT code 69433 is applied to bill the patient’s insurance payer for reimbursement.
Eustachian Tube Dysfunction (ETD)
There are several causes of eustachian tube dysfunction, including sinus infection, allergies, common colds, and even chronic acid reflux (GERD).
Let’s now consider an 18-year-old male who had a seasonal cold the month before. He visits the clinic with an ache and feeling of fullness in his ears. To determine whether the eustachian tubes open and close normally, the physician instructs the patient to close his mouth, pinch his nostrils, and exhale as forcefully as possible.
From the test, he concludes that the tube is blocked, so he performs a tympanostomy (ear surgery) using local anaesthesia in the eardrums. He can use CPT code 69433 for his services in this situation.
Ear Barotrauma
Ear barotrauma is another common type of ear condition that often affects the middle ear. This usually happens while flying in an airplane or deep-water diving.
Assume that a patient has been in the air for more than twenty-one hours. When he gets there, he has strange symptoms like dizziness, nausea, and excruciating ear pain. He sees the ENT specialist nearest to him. After evaluating his condition, the medical professional performs a tympanostomy with topical anesthesia to minimize pain during the procedure. CPT code 69433 will be used to collect reimbursement for this service.
Hearing Loss
Imagine a 68-year-old patient visits the clinic with hearing loss due to persistent fluid buildup in the middle ear. The ENT specialist makes a small incision in the eardrum to suction out or drain the trapped fluid. He performs this procedure using local anesthesia and applies CPT code 69433 for billing.
Recurring Ear Infection
Let’s say a 15-year-old girl who previously saw an ENT for an ear infection returns with the same issue. Initially, the physician tried to cure her condition by giving her an antibiotic, which was of no help. So this time, the physician performs tympanostomy with local anesthesia to cure her repeated ear infections. In this scenario, the physician can apply CPT code 69433.
Applicable Modifiers for CPT Code 69433
Modifiers are appended to the claim to give details about the procedure the physician has performed. Below are a few modifiers that can be appended to the CPT code 69433.
Modifier 50
Modifier 50 represents a bilateral procedure. So if the physician performs tympanostomy on both ears, he can indicate this to the insurance payer by appending Modifier 50.
Modifier LT
In contrast to the above modifier, if the physician performs unilateral tympanostomy on the left ear, he must append the modifier LT with CPT code 69433.
Modifier RT
Similarly, if the physician performed unilateral tympanostomy on the right side, he must append the modifier RT with CPT code 69433.
CPT Code 69433 – Billing & Reimbursement Guidelines
These billing and reimbursement guidelines, particularly for CPT code 69433, will help reduce the probability of claim denials.
Use Accurate Codes
Accurate coding is the most basic prerequisite for accurate reimbursements. A physician or a coder must distinguish between the services and descriptions of two similar codes. For instance, while applying CPT code 69433, the coder must confirm whether the procedure’s anesthesia was local or general. The physician can use this code if topical or local anesthesia was administered to the patient. However, the CPT code 96436 must be used if general anesthesia was administered for the treatment.
Provide Detailed Documentation
Documents work as a liaison between your practice and the insurance payer. If your paperwork delivers inaccurate or incomplete information, this will lead to claim denials or reduced payments.
Therefore, a practitioner must include all relevant information in the documents to collect full reimbursement against CPT code 69433. These include the name and personal details of the patient, his illness or medications, the type of anesthesia used, the procedure’s clinical necessity using the relevant ICD-10 codes, which ear the procedure was performed on (left or right), or both.
Remember the Global Period
The Centers for Medicare and Medicaid Services (CMS) has granted surgeries a time frame known as the Global Period. During this period, every pre-, intra-, and post-operative rendered service is bundled into a single payment.
For CPT code 69433, the global period is 10 days, denoting a minor surgery. Therefore, within these 10 days, if the patient returns to the clinic for discomfort or any other reason, the service will be covered by the insurance payer.
Conclusion
CPT code 69433 reports tympanostomy with local or topical anesthesia. In our guide, we tried to clarify the use of various modifiers that must be appended to CPT code 69433 for specifying laterality and the billing and reimbursement criteria that you must be mindful of when invoicing for this code. However, MediBillMD offers specialized ENT billing services if you require expert assistance.
