Otolaryngology Coding Alert

Question: My otolaryngologist removes an aural polyp and a pressure-equalizing tube. The payer bundled 69424 into 69450. Should I appeal the denial?

Ohio Subscriber

Answer: Unfortunately, the insurer is correct. Payers that follow the National Correct Coding Initiative (NCCI) consider 69424 (Ventilating tube removal requiring general anesthesia) a component of 69450 (Tympanolysis, transcanal). Basically, the edit makes sense: The otolaryngologist has to remove any tube prior to entering the middle ear.

The edit contains a modifier indicator of "1." So if an otolaryngologist removes a tube from one ear (69424) and performs tympanolysis (69450) on the other ear, you can report both procedures with modifier -59 (Distinct procedural service) appended to 69424 to indicate a different side. Make sure to append the appropriate body-side modifiers to each procedure to identify which sides the otolaryngologist performed the procedures on.

The same version (9.0) of NCCI, effective Jan. 1, 2003, also bundles tube removal into all middle-ear incisions (69420-69450), excisions (69501-69554), repairs (69601-69676), as well as foreign-body removal under general anesthesia (69205) and other procedures (69711-69745). Payers that follow NCCI also consider tube removal a component of inner-ear incision (69801-69840), excision (69905-69915), and cochlear device implantation (69930).

- You Be the Coder and Reader Questions answered by Andrew Borden, CCS-P, CPC, CMA, reimbursement manager in the department of otolaryngology and communication sciences at Medical College of Wisconsin in Milwaukee; and Theresa Coats, CPC, office manager at Northland Ear, Nose and Throat in Liberty, Mo.