Otolaryngology Coding Alert
Check NCCI Edits Before Billing These Bundled Codes
Question: Our otolaryngologists would like to bill ear tube removal under general anesthesia and tympanic membrane patch together. Is it appropriate to submit both CPT® codes? Nevada Subscriber Answer: The codes in question for this scenario are 69610 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch) and 69424 (Ventilating tube removal requiring general anesthesia). When your ENTs perform these two procedures on the same ear during a single session, you cannot bill both codes. Why? The National Correct Coding Initiative (NCCI) edits bundle 69424 with 69610 based on the rationale that the physician must remove the tubes prior to repairing the eardrum. Therefore, tube removal is a standard component of the higher-valued tympanic membrane (TM) repair. Bottom line: You should only report 69610. For TM repair in both ears during the same session, append modifier 50 (Bilateral procedure) or -LT (Left side) and -RT (Right side), depending on payer preference.
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