Otolaryngology Coding Alert

Question: During removal of tubes (69424), our otolaryngologist also repaired the tympanic membrane on both ears. How should we code for this?

Answer: Late in 2004, CMS made some revisions to the Physician Fee Schedule database that allowed ENTs to report modifier 50 (Bilateral procedure) with nearly 70 codes with which you couldn't previously apply this modifier. Among the codes affected by the change was 69610 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch).

Therefore, if your ENT repairs tympanic membranes in both ears during the same session, you should report 69610-50. This 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 (this would mean about $240 for the physician portion of a bilateral procedure, versus approximately $160 for the physician portion of a unilateral procedure, using average national Medicare payments).

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 National Correct Coding Initiative bundles 69424 with 69610 because you must remove the tubes prior to repairing the membrane. Therefore, tube removal is a standard component of membrane repair.