A myringotomy (69420, 69421, or S2225) may be performed with or without the insertion of tympanostomy tubes.  Insertion of tubes should be reported under code 69433 or 69436, as appropriate.

Removal of ventilation, myringotomy, or tympanostomy tubes (i.e., Shea or Collar button) may be paid when performed under general anesthesia (69424).

However, removal of such tubes is considered an integral part of a doctor's medical care when not performed under general anesthesia, and therefore, is not eligible as a distinct and separate service.

If the removal of ventilation, myringotomy, or tympanostomy tubes (69799) is reported on the same day as medical care, and the charges are itemized, combine the charges and pay only the medical care.  Payment for the medical care performed on the same date of service includes the allowance for the tube removal.  A participating, preferred, or network provider cannot bill the member separately for the tube removal in this case.

If the removal of ventilation, myringotomy, or tympanostomy tubes is performed independently, process it under the appropriate code.

Modifier 25 may be reported with medical care to identify it as a significant, separately identifiable service from the removal of ventilation, myringotomy, or tympanostomy tubes (69799). When the 25 modifier is reported, the patient’s records must clearly document that separately identifiable medical care has been rendered.

Description

A myringotomy (tympanostomy) is a small incision made in the eardrum for the purpose of relieving the build-up of fluid and pressure in the middle ear that causes recurrent ear infections.