Otolaryngology Coding Alert

Question: Our ENT performed a myringoplasty (69620) with a fat graft. A week later, she documented a failed myringoplasty and scheduled a tympanoplasty (69631). On the second surgery, what modifier should I use? Should we consider the second surgery staged even though it was not planned?

Indiana Subscriber

Answer: Append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to 69631 (Tympanoplasty without mastoidectomy [including canalplasty, atticotomy and/or middle ear surgery], initial or revision; without ossicular chain reconstruction) as your physician did not get the outcome she wanted and is doing a more extensive subsequent surgery than the original 69620 (Myringoplasty [surgery confined to drumhead and donor area]).