Otolaryngology Coding Alert

Question: In the August 1999 Otolaryngology Coding Alert on page 12, you use the example of 31505 and 69210-51; yet, later in the article, you state that distinct and individual procedures should use a -59 modifier. Code 31505 (laryngoscopy, indirect; diagnostic [separate procedure]) and 69210 (removal impacted cerumen [separate procedure], one or both ears) are about as distinct and separate as you can get. Why not bill them as 31505 and 69210-59?

Anonymous Washington Subscriber

Answer: Modifier -59 (distinct procedural service) was developed by CPT in response to Medicares national Correct Coding Initiative and is used correctly only when procedures normally are bundled. Occasionally, two procedures that normally would be bundled (a good example is excisions of lesions) need to be reported separately because the procedures were performed on different locations in the body, or at different times during the same 24-hour period. Only in such situations should modifier -59 be used.

Even though both these codes are separate procedures, they may be billed together because each is being performed on totally separate anatomic systems (i.e., the throat and the ears) and as such would never be bundled. As with other ordinary multiple procedures, some carriers want to see modifier -51 (multiple procedures) attached, whereas others just want the procedures listed.