Otolaryngology Coding Alert

Question: Can you explain how this case should be coded?

The otolaryngologist gently debrides the margins of the right ear perforation. Following this, they place Gelfoam^® pledgets in the middle-ear space to prevent the fat graft from falling medially. Next, they incise the inferior portion of the earlobe, and a fat graft was harvested. The ENT closes the wound with a running suture of 6-0 mild chromic. They use the fat graft to plug the hole in the TM in a dumbbell-shaped fashion. Finally, the surgeon places Gelfoam^® pledgets around the perforation to hold the fat graft securely in place.

Georgia Subscriber

Answer: Proper reporting for this repair is 69620 (Myringoplasty (surgery confined to drumhead and donor area)) with modifier RT (Right side) appended. The key here is that the surgeon used a fat graft to repair the ruptured tympanic membrane (TM). Don’t get thrown off by the ENT’s use of Gelfoam^® to secure the fat graft in place. In some instances, the otolaryngologist may use Gelfoam^®, or a paper patch, in addition to a harvested fat graft as a means of further securing the repair.

Furthermore, you should not consider reporting both 69610 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch) and 69620 because the surgeon relies on a patching technique alongside the placement of the fat graft. A National Correct Coding Initiative (NCCI) edits check reveals a modifier indicator of 1 when pairing these codes. With 69610 being the column 2 code, the only instance in which you should use an overriding modifier to separately report 69610 alongside 69620 is when the surgeon performs each service on contralateral ears. When appropriate, you may use modifiers, such as XS (Separate structure …), 59 (Distinct procedural service), LT (Left side), and RT, to override the NCCI edit.