Advanced Search

Otolaryngology Coding Alert

Reader Questions:

Prove Medical Necessity Before You Can Code 69440

Published on Wed May 18, 2011

Question: What is the appropriate CPT® for Silverstein permanent aeration tube? The surgery took 1.5 hours. My physician would like to report 69440 but I'm not so sure.Maine SubscriberAnswer: You have two choices: (1) use the unlisted codes, or (2)use modifier 22 (Increased procedural service) with 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia) to describe the increased service. Make sure you create a standard letter describing the procedure, what differentiates it from standard tube placement, and the medical benefits for the patient over standard tubes (i.e., why should payer pay for the Silverstein tubes) to use to appeal and get paid appropriately.Important: If the op note does not show middle ear exploration, you cannot bill 69440 (Middle ear exploration through postauricular or ear canal incision). Even if the op note shows middle ear exploration but does not show medical necessity for doing the exploration, you still cannot code [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Otolaryngology Coding Alert

View All