How To Use CPT Code 69436

CPT 69436 is a code for tympanostomy requiring insertion of a ventilating tube under general anesthesia. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 69436 procedures.

1. What is CPT 69436?

CPT 69436 is a medical billing code used to describe a tympanostomy procedure that requires the insertion of a ventilating tube under general anesthesia. This code is specifically used when the procedure is performed in an operating room setting and involves the use of general anesthesia.

2. 69436 CPT code description

The official description of CPT code 69436 is: “Tympanostomy (requiring insertion of ventilating tube), general anesthesia.”

3. Procedure

1. The patient is prepped and draped in a sterile fashion.
2. General anesthesia is induced using an appropriate anesthetic agent.
3. A myringotomy is performed to create an opening in the eardrum.
4. A delicate tympanostomy tube is inserted into the eardrum to provide continuous drainage for infectious fluid in the middle ear and to keep the middle ear aerated, preventing the accumulation of mucus.
5. The tympanostomy tube is secured in place.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 69436 services are those who require a tympanostomy procedure with the insertion of a ventilating tube under general anesthesia. This typically includes patients with chronic or recurrent middle ear infections, persistent fluid in the middle ear, or eustachian tube dysfunction that has not responded to conservative treatments such as antibiotics or decongestants.

5. When to use CPT code 69436

It is appropriate to bill the 69436 CPT code when a physician performs a tympanostomy in an operating room using general anesthesia. If the provider performs an office-based tympanostomy using local or topical anesthesia, the appropriate code is CPT 69433. However, CPT 69436 does not include anesthesia services, and the anesthesiologist should bill their own code for that according to the time the patient was anesthetized.

6. Documentation requirements

To support a claim for CPT 69436, the following information should be documented:

• Patient’s medical history and physical examination findings
• Indications for the tympanostomy procedure, such as chronic or recurrent middle ear infections, persistent fluid in the middle ear, or eustachian tube dysfunction
• Details of the procedure, including the use of general anesthesia, myringotomy, and insertion of the tympanostomy tube
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 69436, keep in mind that the supply of the tympanostomy tube is included with the procedure, so you should not report 99070 for the tube itself. If the procedure is performed bilaterally, report CPT 69436 with modifier 50. Remember that the anesthesiologist should bill their own code for anesthesia services, as CPT 69436 does not include these services.

8. Historical information

CPT 69436 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 69436

Five similar codes to CPT 69436 and how they differentiate are:

1. CPT 69433: Tympanostomy without general anesthesia, typically performed in an office setting using local or topical anesthesia.
2. CPT 69420: Myringotomy without insertion of a ventilating tube.
3. CPT 69421: Myringotomy with aspiration and/or injection of medication.
4. CPT 69424: Ventilation tube removal under general anesthesia.
5. CPT 69425: Ventilation tube removal without general anesthesia, typically performed in an office setting using local or topical anesthesia.

10. Examples

1. A 5-year-old child with recurrent middle ear infections undergoes a tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 is billed for the procedure.
2. A patient with persistent fluid in the middle ear and eustachian tube dysfunction undergoes a tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 is billed for the procedure.
3. A patient with a history of chronic middle ear infections undergoes a bilateral tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 with modifier 50 is billed for the procedure.
4. A patient with a history of eustachian tube dysfunction undergoes a tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 is billed for the procedure.
5. A patient with a history of recurrent middle ear infections undergoes a tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 is billed for the procedure.
6. A patient with persistent fluid in the middle ear undergoes a tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 is billed for the procedure.
7. A patient with a history of chronic middle ear infections undergoes a tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 is billed for the procedure.
8. A patient with a history of eustachian tube dysfunction undergoes a tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 is billed for the procedure.
9. A patient with a history of recurrent middle ear infections undergoes a tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 is billed for the procedure.
10. A patient with persistent fluid in the middle ear undergoes a tympanostomy with insertion of ventilating tubes under general anesthesia in an operating room setting. CPT 69436 is billed for the procedure.