Otolaryngology Coding Alert

Question: An otolaryngologist removes tubes (69424-50, Ventilating tube removal requiring general anesthesia) and has to repair the tympanic membrane on both ears. How should I report the repair?

Michigan Subscriber Answer: You should report the repair bilaterally by appending modifier 50 (Bilateral procedure) to 69610 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch). In 2005, CMS changed the bilateral surgery indicator of 69610, as well as 64 auditory codes (69440-69979 except 69676, 69710).

Otolaryngologists previously had to perform these surgeries separately. Otherwise, Medicare wouldn't pay for both ear operations.

Your otolaryngologist can perform these surgeries bilaterally -- and you can bill for both. Medicare will then apply the bilateral adjustment (150 percent) to the code. Make sure to report the code on a single line:

- 69610-50. Tip: If a private insurer doesn't allow bilateral billing of 69610, send the payer a copy of the 2006 National Physician Fee Schedule indicating 69610's bilateral status of -1,- meaning a 150 percent payment adjustment for bilateral procedures applies.