Wiki ENT Adenoidectomy/tympanostomy

[lbusby2]

Okay, I need some help. Should their be a modifier attached to the 69436, other than bilateral when these are done at some surgical session?

42830 (Adenoidectomy)
69436-50 (bilateral Tympanostomy (requiring insertion of ventilating tube).

Problem: EncoderPro says need modifier 51 to 69436, but these are 2 different organ systems, so wouldn't 59 be more appropriate.

Also, if you go to CMS CCI code edits, these 2 are not listed together?

Help. Claim is being denied when modifier 59 is being added to 69436.

Please add rationale..Thanks
Lynn

 

[AuntJoyce]

Ent...

Hi Lynn,

Wondering who the payer is...sometimes that makes a world of difference.

I agree that the -59 modifier is the way to go (since MOST carriers refuse to acknowledge of accept -50). If you received a denial, my best advise is to submit a paper appeal with the op report showing that both the right and left ears were involved.

The other consideration of course would be to submit the claim with -RT and -LT modifiers...again, depends on the payer.

If it wasn't for the high amount of denials issued DAILY, what else would the insurance companies have to do? Oh yeah, pay our claims!

Coding/billing is like sailing on the Titanic...though sometimes I think that would have been more comfortable...yikes.

Hope this was of a little bit of help at least.

Have a great weekend.

Joyce