Wiki Billing 69620 and 69424 with 59 modifier

Create Wiki
C

chickelala

Guest
Messages
6
Best answers
0
We are having an office debate. I have always had the understanding that there is a known CCI edit that prevents billing 69620 with 69424. I know that 69424 would be payable if we attached the 59 modifier, but I have never run across a situation where I felt it was appropriate to add that modifier.

After a recent trip to a coding bootcamp, my lead coder shared with us that there was a substantial discussion among the coders there about this issue. It was suggested that most coders are adding the 59 modifier on a regular basis and billing these 2 codes together.

I would be interested to know if other coders in this specialty typically are billing 69620 and 69424-59 on a regular basis.

Thanks!
 
Adding a modifier 59 simply to turn of an NCCI edit is incorrect billing, you are correct in your hesitation and rightful concern. Just because you can, doesn't mean you should. The edits were created for this code pair because 75% of all surgeons were performing them, making it necessary to bundle them together when done on the same anatomical area. "Allowed" does not mean you have permission to add a modifier 59 without meeting the requirements.

The only time you can bill the two codes at the same surgical session would be if they were performed on contralateral eardrums.
 
If the myringoplasty is being performed one a separate ear, then -59 would be appropriate.

The physician must remove the tube to enter the middle ear ,therefore the tube removal is truly incidental if he/she is only removing the tube to enter the middle ear space.

It all depends on the situation, I would tread carefully before utilizing -59 on every claims unless your medical necessity warrants it.

:)


 
So if my doctor did the following procedures:

PROCEDURE PERFORMED:
1. Fat graft myringoplasty, right tympanic membrane.
2. Removal of left ear tube and paper patch myringoplasty.

Would I be able to bill for both the 69620-50 and 69424-59?
Your help is appreciated:)
 
You must log in or register to reply here.
Top