Otolaryngology Coding Alert

Question: An otolaryngologist performs two tympanoplasties at different sessions for the same ear problem. Should I use modifier -58, -78 or -79 on the second surgery?

The patient undergoes 69641 on the left ear and two months later 69635 on the right ear.


Virginia Subscriber


Answer: You should append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to 69635 (Tympanoplasty with antrotomy or mastoidotomy [including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair]; without ossicular chain reconstruction). The modifier tells the insurer that the otolaryngologist staged the two sides.
 
Before performing the initial tympanoplasty (69641, Tympanoplasty with mastoidectomy [including canalplasty, middle ear surgery, tympanic membrane repair]; without ossicular chain reconstruction), the surgeon planned on first operating on the left ear and then at a later date operating on the right ear.

The other postoperative modifiers - -78 (Return to the operating room for a related procedure during the postoperative period) and -79 (Unrelated procedure or service by the same physician during the postoperative period) - don't accurately describe how the second tympanoplasty relates to the postoperative period. 
 
Why: Modifier -78 would indicate that the patient had a complication that required the otolaryngologist to return to the operating room. The second tympanoplasty is on the other ear, so it's not a complication.

Modifier -79 tells the insurer that the second tympanoplasty doesn't relate to the first tympanoplasty. But the procedures are related - as you indicate, the patient needed the operations for the same ear problem.