Otolaryngology Coding Alert

Question: During tube removal (69424), our otolaryngologist repaired the tympanic membrane on both ears. How should we code for this?

Rhode Island Subscriber

Answer: If your ENT repairs tympanic membranes in both ears during the same session, you should report 69610-50 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch; bilateral procedure). Modifier 50 tells the payer the physician treated both ears and should allow you to receive 50 percent higher reimbursement for the physician's extra work.

In 2004, CMS revised the Physician Fee Schedule database to allow ENTs to report modifier 50 with nearly 70 codes you couldn't previously append this modifier to. Among the codes affected by the change was 69610.

Forget the tubes: You may not report tube removal 69424 (Ventilating tube removal requiring general anesthesia) -- whether unilateral or bilateral -- with bilateral tympanic membrane repair. The Correct Coding Initiative bundles 69424 with 69610 because you must remove the tubes to repair the membrane.