Outpatient Facility Coding Alert

Question:  Our physician removed a patient’s ear tubes in an ASC setting under MAC anesthesia (instead of general). If he either inserts or removes tubes under these circumstances, can we report 69424 with modifier 52 instead of submitting the unlisted procedure code?

New York Subscriber

Answer:  A quick glance shows that 69424 (Ventilating tube removal requiring general anesthesia) applies to procedures involving general anesthesia. If you report the code with modifier 52 (Reduced services), the payer will expect to see documentation that the surgeon performed less than the procedure represented by the code, not a different type of anesthesia.   

Until there is an editorial change to 69424 to include sedation, the most appropriate code to report when the surgeon uses sedation is still 69799 (Unlisted procedure, middle ear). The documentation you submit with the claim will explain the surgeon’s service and why you’re reporting 69799 instead of 69424.