Wiki 2ND REQ-Tube removal & Medicaid

[dyoungberg]

ASC Setting-Dr removed ear tubes from 6year old under general anesthesia. I billed with 69424 to Medicaid. They have denied as not covered.

Here is the Op Note:

POSTOPERATIVE DIAGNOSIS: 1.HISTORY OF OTITIS MEDIA
2.RETAINED PE TUBE/IMPLANT, LEFT EAR

PROCEDURE: EXAMINATION UNDER ANESTHESIA WITH DEBRIDEMENT OF RETAINED IMPLANT

ANESTHESIA: GENERAL GAS

FINDINGS:
1. Left ear tube in the ear canal, deeply impacted with cerumen, intact tympanic membrane, no middle ear effusion.
2. The right side has cerumen, requiring cleaning, intact tympanic membrane, no effusion.

COMPLICATIONS: NONE

INDICATIONS: The patient presents with a history of ear infection several years ago and had PE tubes which have never fallen out the ear canal. Removal in the office is difficult due to poor cooperation from the patient.

DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative area and was taken to the OR and placed supine on the OR table. Gas anesthesia was induced. Using the operating microscope the left ear was well visualized through a speculum. The PE tube was visible. This was removed with a curette. It is deeply embedded with impacted cerumen. The ear canal was then irrigated and suctioned dry. The tympanic membrane was clear, no effusion.

Next the right ear was visualized. There is also cerumen only present. This was cleaned. Tympanic membrane is clear. The patient was then handed back to Anesthesia, tolerated the procedure well.


Did I bill this correctly and if so, has anyone had any luck billing for this to Medicaid from ASC and getting paid? If so, how did you appeal?

Thanks very much!
Debbie
NW FL Surgery Center

 

[purinoski]

The operative report does not indicate that doc removed the tubes, only that he removed cerumen. MEDICAID does not reimburse for removal of cerumen unless there is an unruly child and pre-authorization has been received. Was the claim filed electonically, and what did you have as dx code?

Phyllis Urinoski, CPC
South AL Outpt Svcs
Enterprise, AL

 

[dyoungberg]

Phyllis thanks for responding. Within the op note it states "The PE tube was visible. This was removed with a curette. It is deeply embedded with impacted cerumen." We file electronically and I filed with DX code 385.83.

So am I understanding that if we get pre-approval for tube removal under anesthesia, Medicaid will pay for it?

Debbie Youngberg, CPC-a
NW FL Surgery Center
Panama City, FL