Otolaryngology Coding Alert

Question: An otolaryngologist implants a cochlear device with mastoidectomy on both ears. Should I use modifier 50 or 59?

Texas Subscriber

Answer: The 2008 Medicare Physician Fee Schedule allows you to report a cochlear device with mastoidectomy bilaterally. Column Z "Bilat Surg" of the fee schedule lists a "1" for 69930 (Cochlear device implantation, with or without mastoidectomy). For payers that recognize modifier 50 (Bilateral procedure), you should report on one line:

- 69930-50.

Medicare's bilateral-surgery rules pay the first surgery at 100 percent and the second-side surgery at 50 percent. Expect 69930-50 to pay about $1,880 using the Medicare fee schedule.

Loss averted: Check your explanation of benefits (EOB) for payment on 69930-50 to make sure the insurer paid you for the bilateral procedure. If you don't have the payer's fee schedule, use the benchmark of $1,880 or compare the rate to unilateral 69930 charges to ensure you didn't receive payment for one side only.

Some insurers require you to report bilateral surgeries with units or with modifier 59 (Distinct procedural service) and body-side modifiers (LT, Left side and RT, Right side). In these cases, you would instead assign 69930 x 2 on one line or use the following on two lines:

- 69930-LT

- 69930-59-RT.

Catch this: Medicare changed 69930's status from unilateral to bilateral, effective Oct. 1, 2004. The fee schedule change from "0" (150 percent payment adjustment for bilateral procedures does not apply) to "1" (150 percent payment adjustment for bilateral procedures applies) applies to otolaryngology codes 69440-69979 (except 69676, which already contained "1," and 69710 for which the concept does not apply, indicated by the "9" modifier). This means you can also report mastoidectomy (69501-69511, 69601-69605) and tympanoplasty (69631-69646) bilaterally.