Otolaryngology Coding Alert
Include All Applicable Procedures in 69540
Question: Can I report both tympanostomy tube removal and aural polyp removal under general anesthesia? The otolaryngologist performed both procedures during the same operative session. Modifier 59 (Distinct procedural service) informs the payer that the tube removal occurred on a separate site from the excision. The body-side modifiers (LT, Left side; RT, Right side) further explain the separate locations.
Colorado Subscriber
Answer: The National Correct Coding Initiative version 12.1 bundles the tube removal (69424, Ventilating tube removal requiring general anesthesia) into the aural polyp excision (69540, Excision aural polyp). Therefore, you should report only 69540. Keep in mind that the physician must remove the tube to enter the middle ear and excise the polyp, and therefore the tube removal is truly incidental.
Separate-side exception: As with other bundling edits of this type, you may override the edits if the ENT performs separate-side polyp excision and tube removal. For instance, if an otolaryngologist performs bilateral tube removal and excises an aural polyp from a patient's left ear, you should report:
69540-LT
69424-59-RT.
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