Otolaryngology Coding Alert

Receive 150 percent payment for patching both ears after tube removal

When your otolaryngologist performs complex ear surgeries bilaterally, CMS now allows you to bill this combination. 

CMS Approves Bilateral Status for 65 Auditory Codes

You can now code over 60 middle and inner ear procedures bilaterally, thanks to a change in Medicare's fee schedule.

Old way: If a patient required bilateral middle, inner or temporal bone ear surgery, you previously had to perform the operations separately. Otherwise, Medicare wouldn't pay for both ear operations.

New way: Your otolaryngologist can perform the surgeries together - and you can bill for both. For a complete list of affected codes, see "You May Append Modifier -50 to These Auditory Codes" later in this issue.

Why: CMS changed the bilateral surgery indicator of 65 auditory codes (69440-69979 - except 69676, 69710). "A specialty society sent us an e-mail stating that the indicators were incorrect," says Gaysha Brooks, health insurance specialist at CMS. The American Academy of Otolaryngologists-Head and Neck Society (AAO-HNS) argued that the codes should be eligible as bilateral procedures.

CMS agreed with the AAO-HNS. Medicare issued the change in a National Physician Fee Schedule Relative Value File (NPFSRVF) October 2004 update. "The 2005 NPFSRVF includes the revision," Brooks says.

Modifier -50 Nets You 150 Percent

The fee schedule revision means you can bill affected bilateral ear surgery codes on claims starting Oct. 1, 2004. Append modifier -50 (Bilateral procedure) to the appropriate procedure. Medicare will then apply the bilateral adjustment - 150 percent - to the code.

Example: An otolaryngologist performs a complete mastoidectomy on a patient's right and left ear. You should report on a single line:
 

69502-50 - Mastoidectomy; complete; bilateral procedure.

Payment: Medicare will pay the claim at a national rate of $1,418. 31 (24.95 relative value units [RVUs]) or 150 percent of 69502's payment of $945.54.

Despite CMS giving a green light to bilateral complex ear surgery billing, how much you use this benefit will depend on your otolaryngologists' work mix.

The change won't affect her practice, says Chrissy Rogan, CPC, billing coordinator at Metropolitan ENT, with four otolaryngologists in Alexandria, Va. "Our otolaryngologists would not operate on both ears at the same time because of the comfort factor." Patients postoperatively have to wear ear protectors that diminish hearing.

On the other hand, pediatric ENTs and otologists may find the change beneficial. "When an otolaryngologist removes tubes (69424-50, Ventilating tube removal requiring general anesthesia), he sometimes has to repair the tympanic membrane on both ears, says Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor. "Otolaryngologists can now report the repair bilaterally with 69610-50 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch)."