4 Steps Ensure That You Won't Sacrifice $550+ In Mastoidectomy Pay
Published on Wed May 05, 2004
Experts show you when to use the 10 initial mastoidectomy codes With more than $550 at stake, you can't afford to report your otolaryngologist's mastoidectomy procedures incorrectly.
But the 10 initial mastoidectomy codes are among the most challenging otolaryngology codes to understand. "I usually have to go with what the surgeon marks because I find the codes redundant in terminology," says Julie Robertson, CPC, an otolaryngology coding and reimbursement specialist for University ENT Specialists, a 15-otolaryngologist practice in Cincinnati.
But you can confidently report mastoidectomy (69502-69511) and tympanoplasty with mastoidectomy (69641-69646) codes if you follow these steps: 1. Choose Initial Mastoidectomy Section You should determine whether the surgery involves a mastoidectomy or a tympanoplasty with mastoidectomy. For a mastoidectomy, you should use a code from the first initial mastoidectomy section:
69501 -- Transmastoid antrotomy (simple mastoidectomy)
69502 -- Mastoidectomy; complete
69505 -- ... modified radical
69511 -- ... radical. Coding these procedures correctly can be lucrative to your ENT practice. These codes pay between $631.05 and $915.20, based on the 2004 National Physician Fee Schedule.
If your otolaryngologist performs a tympanoplasty with mastoidectomy, you should choose a code from the second initial mastoidectomy section:
69641 -- Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction
69642 -- ... with ossicular chain reconstruction
69643 -- ... with intact or reconstructed wall, without ossicular chain reconstruction
69644 -- ... with intact or reconstructed canal wall, with ossicular chain reconstruction
69645 -- ... radical or complete, without ossicular chain reconstruction
69646 -- ... radical or complete, with ossicular chain reconstruction. Medicare pays between $867.41 and $1,198.99 for these procedures, unadjusted for geographic differences.
Watch out: You could miss out on the mastoidectomy fee if you overlook the mastoid removal operation in the physician's procedure notes. "When an otolaryngologist performs a tympanoplasty to remove cholesteatoma, we often miss the mastoidectomy," says George E. Smaistrla Jr., FHFMA, clinic administrator at the three-ENT prac-tice Associated Otolaryngologists of Decatur, in Illinois.
Tip: You can avoid omitting the mastoidectomy, an error that could cost you between $236.36 and $567.94, by looking for the word "mastoid" in the tympanoplasty operative note, Smaistrla says.
Example: An otolaryngologist enters the middle ear through a canal skin flap, drills out the diseased mastoid air cells and places a piece of muscle tendon beneath
the perforation.
Action: If you highlight "mastoid" in the above operative note, you will most likely remember to use a code for tympanoplasty with mastoidectomy (69641-69646) instead of a code for tympanoplasty (69635-69646). 2. Simple, Complete, Modified Radical or Radical To select a mastoidectomy-only code, you should determine the mastoidectomy type:
simple (69501)
complete (69502)
modified radical (69505)
radical (69511). Snag: The terms may look easy, but your otolaryngologist may not use these exact [...]
