CPT for ENT: Transtympanic Therapeutic Injections

Transtympanic therapeutic injections are a common procedure performed by otolaryngologists for various otologic conditions, such as sudden sensorineural hearing loss and severe cases of vertigo when observed in some patients with Meniere’s disease. A patient may use any variety of medications, and the patient may need a single injection, or a series of injections performed over multiple days.

For each separate encounter/instillation (separate ear, separate day), report CPT code 69801, Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal (Do not report 69801 more than once per day) (Do not report 69801 in conjunction with 69420, 69421, 69433, 69436 when performed on the same ear)

Since code revision in 2011, 69801 now has a zero-day global period and the tube placement is included in the code. The instilled medication is reported separately using a HCPCS code.

As always, ensure your documentation fully supports your treatment rationale and coincides with the CPT codes submitted in the claim. Be prepared to send clinical notes if the claims examiner needs further information to process the claim.

Reviewed October 2023

IMPORTANT DISCLAIMER NOTICE

CPT FOR ENT ARTICLES ARE A COLLABORATIVE EFFORT BETWEEN THE ACADEMY’S TEAM OF CPT ADVISORS, MEMBERS OF THE PHYSICIAN PAYMENT POLICY (3P) WORKGROUP, AND HEALTH POLICY STAFF. ARTICLES ARE DEVELOPED TO ADDRESS COMMON CODING QUESTIONS RECEIVED BY THE HEALTH POLICY TEAM, AS WELL AS TO CLARIFY CODING CHANGES AND CORRECT CODING PRINCIPLES FOR FREQUENTLY REPORTED ENT PROCEDURES. THESE ARTICLES ARE NOT INTENDED AS LEGAL, MEDICAL, OR BUSINESS ADVICE AND ARE NOT A GUARANTEE OF REIMBURSEMENT. THE INFORMATION IS ALSO NOT MEANT TO SERVE AS THE DEFINITIVE OR SOLE AUTHORITY ON BILLING AND CODING ISSUES. THE APPLICABILITY OF AAO-HNS BILLING AND CODING GUIDANCE FOR A PARTICULAR PROCEDURE, MUST BE DETERMINED BY THE RESPONSIBLE PHYSICIAN IN LIGHT OF ALL THE CIRCUMSTANCES PRESENTED BY THE INDIVIDUAL PATIENT. YOU SHOULD CONSULT WITH YOUR OWN ADVISORS AS WELL AS MEDICARE OR PRIVATE CARRIERS IN MAKING ANY DECISIONS ABOUT HOW TO BILL AND CODE PARTICULAR SERVICES OR PROCEDURES.