CPT Assistant, April 2021, Volume 31, Issue 4, page 12
For the Current Procedural Terminology (CPT®) code set, two new Category I codes (69705, 69706) were added to the Middle Ear subsection of the Auditory System section. This article provides an overview of these new codes.
Middle Ear
Other Procedures
(Do not report 69705, 69706 in conjunction with 31231, 92511)
Prior to 2021, there was no specific CPT code to report surgical nasopharyngoscopy with dilation of the eustachian tube (ie, balloon dilation). This procedure was previously reported with code 69799, Unlisted procedure, middle ear.
The new procedure is clinically referred to as eustachian tube balloon dilation (ETBD), which may be performed for the treatment of disorders related to middle ear aeration or ventilation (eg, obstructive eustachian tube dysfunction [OETD]) contributing to middle ear effusion and related disorders (eg, retraction pockets, cholesteatoma, atelectatic otitis media).
Although inflation of the eustachian tube is included in codes 69420, Myringotomy including aspiration and/or eustachian tube inflation, and 69421, Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia, these inflation procedures are performed through an incision in the eardrum and do not describe nasopharyngoscopic ETBD. An exclusionary parenthetical note was added after code 69706 to indicate that codes 69705 and 69706 should not be reported with code 31231, Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure), or 92511, Nasopharyngoscopy with endoscope (separate procedure).
The following clinical examples and procedural descriptions reflect typical clinical situations for which codes 69705 and 69706 would be appropriately reported.
Clinical Example (69705)
A 45-year-old female with adult life-long history of difficulty equalizing her left ear with altitude changes develops a left middle ear effusion after a flight. Despite medical management over 3 months, her left middle ear effusion persists with a type B tympanogram and conductive hearing loss. She is scheduled for surgical nasopharyngoscopy with left eustachian tube dilation.
Description of Procedure (69705)
Remove previously placed pledgets. Under endoscopic visualization, place pledgets soaked in decongestant and anesthetic in the nasopharynx followed by a wait-time for them to take effect. Remove pledgets and inject an intranasal anesthetic/vasoconstrictive agent into the middle turbinate followed by a wait-time for this to take effect. Holding the guide catheter by the proximal hub and under endoscopic visualization, insert it through the nose on the side to be treated and near the orifice of the eustachian tube. Then rotate and stabilize the guide catheter so that the tip angle is aligned with the trajectory of the eustachian tube. Advance the balloon catheter through the guide into the eustachian tube. Inflate the balloon to the desired pressure while monitoring the diameter, shape, and position of the balloon under endoscopic visualization and monitoring for any signs of bleeding from the internal carotid artery. Perform additional inflation followed by balloon deflation, retract into the guide catheter, and remove along with the entire system.
Clinical Example (69706)
A 56-year-old male with adult life-long history of difficulty equalizing his ears with flights develops an upper respiratory infection and subsequent middle ear effusion bilaterally. Despite medical management over three months, his middle ear effusions persist with type B tympanograms and conductive hearing loss. He is scheduled for surgical nasopharyngoscopy with bilateral eustachian tube dilation.
Description of Procedure (69706)
Remove previously placed pledgets. Under endoscopic visualization, place pledgets soaked in decongestant and anesthetic in the nasopharynx followed by a wait-time for them to take effect. Remove pledgets and inject an intranasal anesthetic/vasoconstrictive agent into the middle turbinate followed by a wait-time for this to take effect. Holding the guide catheter by the proximal hub and under endoscopic visualization, insert it through the nose on the side to be treated and near the orifice of the eustachian tube. Then rotate and stabilize the guide catheter so that the tip angle is aligned with the trajectory of the eustachian tube. Advance the balloon catheter through the guide into the eustachian tube. Inflate the balloon to the desired pressure while monitoring the diameter, shape, and position of the balloon under endoscopic visualization and monitoring for any signs of bleeding from the internal carotid artery. Perform additional inflation followed by balloon deflation, retract into the guide catheter, and remove along with the entire system. Repeat the entire procedure on the contralateral side.
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