Otolaryngology Coding Alert

Question: An otolaryngologist removes a foreign body from both ears under anesthesia. Should I bill the procedure code bilaterally?

New York Subscriber

Answer: To determine whether the code is eligible for bilateral billing, you should look up the foreign-body removal code in the National Physician Fee Schedule Relative Value File. Column "Z" will give you the answer. If the column contains a:

• 0 -- the code is not eligible for bilateral billing due to anatomy or the code's description
• 1 -- you may bill the code bilaterally
• 2 -- the code already includes bilateral payment
• 3 -- Medicare does not subject the code (which you bill bilaterally) to bilateral payment adjustments
• 9 -- the concept does not apply.

Column Z of the Fee Schedule lists a "0" for 69205 (Removal foreign body from external auditory canal; with general anesthesia). Therefore, you should not bill 69205 bilaterally with modifier 50 (Bilateral procedure).

Right way: You should instead use modifier 59 (Distinct procedural service) on the second listing of 69205 (69205-59). Otherwise, the insurer will deny the second foreign-body removal as a duplicate procedure. You can also add modifiers LT (Left side) and RT (Right side) as follows:

69205-LT

69205-59-RT

Did you know? On Codify, you can pull up a code and find the bilateral indicator.