Otolaryngology Coding Alert

Question: During removal of tubes (69424), our otolaryngologist also repaired the tympanic membrane on both ears. How should we code this? Am I allowed to use modifier 50?

Nevada 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).

Applying modifier 50 tells the payer that the physician treated both ears, and should allow you to receive 50 percent higher reimbursement than usual to account for the additional physician work. In other words, the Medicare non-geographical adjusted fee for 69610 is $275.19, and Medicare would add an additional 50 percent to the allowance for the second side. That would mean an additional $137.60, bringing the total allowance for 69610-50 to $412.79 (Medicare non-geographical adjusted).

Watch out: In addition, 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 (CCI) bundles 69424 with 69610. The rationale is that the physician must remove the tubes prior to repairing the membrane. Therefore, tube removal is a standard component of membrane repair.

-- Answers to You Be the Coder and Reader Questions provided/ reviewed by Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.