Otolaryngology Coding Alert

Question: During removal of tubes (69424), our otolaryngologist also repaired the tympanic membrane on both ears. How should we code this? Am I allowed to use modifier 50? Nevada Subscriber Answer: If your ENT repairs tympanic membranes in both ears during the same session, you should report 69610-50 (Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch; Bilateral procedure). Applying modifier 50 tells the payer that the physician treated both ears, and should allow you to receive 50 percent higher reimbursement than usual to account for the additional physician work. In other words, the Medicare non-geographical adjusted fee for 69610 is $275.19, and Medicare would add an additional 50 percent to the allowance for the second side. That would mean an additional $137.60, bringing the total allowance for 69610-50 to $412.79 (Medicare non-geographical adjusted). Watch out: In addition, you may not report tube [...]