Otolaryngology Coding Alert

Question: An otolaryngologist removes a foreign body from both ears under anesthesia. Should I bill the procedure code bilaterally?


New York Subscriber


Answer: To determine whether the code is eligible for bilateral billing, you should look up the foreign-body removal code in the National Physician Fee Schedule Relative Value File. Column -Z- will give you the answer. If the column contains a:

- 0--the code is not eligible for bilateral billing due to anatomy or the code's description

- 1--you may bill the code bilaterally

- 2--the code already includes bilateral payment

- 3--Medicare does not subject the code (which you bill bilaterally) to bilateral payment adjustments

- 9--the concept does not apply. Column Z of the Fee Schedule lists a -0- for 69205 (Removal foreign body from external auditory canal; with general anesthesia). Therefore, you should not bill 69205 bilaterally with modifier 50 (Bilateral procedure).

Right way: You should instead use modifier 59 (Distinct procedural service) on the second listing of 69205 (69205-59). Otherwise, the insurer will deny the second foreign-body removal as a duplicate procedure.

Also: Your Medicare intermediary should have a Web site that has information by code. You can pull up a code and find the bilateral indicator.