Otolaryngology Coding Alert

Failing to bill commercial payers for 69990 when performed in addition to middle and inner ear surgeries will sacrifice more than $128 for your ENT's work.

Medicare does not allow +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) with middle and inner ear surgeries. Therefore, when an otolaryngologist performs microdissection during complicated ear surgeries, many otolaryngologists and otolaryngology coders question if they should report 69990. Using 69990 as an add-on when doing 69500 (excision) and 69600 (repair) series procedures seems appropriate, writes David G. Bailey, MD, an ENT in Marion, Ohio.

The National Correct Coding Initiative (NCCI) bundles microsurgical techniques, requiring use of operating microscope (OM) into ear surgery codes (69501-69554, middle ear excision; 69601-69676, middle ear repair; and 69905-69915, inner ear excision). "This edit is a budgetary one and does not have a clinical basis," says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. Thus, for third-party payers that do follow NCCI, you may report the microsurgery add-on code in addition to complex ear surgery, she says.

Billing All Payers the Same Will Cost You Money

The NCCI edits apply to Medicare and Medicaid, but because the bundle does not have clinical support, in this case you should use different billing methods to your advantage. "Many coders forget that you do not have to bill all insurers the same way," says Andrew Borden, CCS-P, CPC, CMA, reimbursement manager in the department of otolaryngology and communication sciences at Medical College of Wisconsin in Milwaukee.

Medicare uses NCCI edits to explain what it thinks is appropriate coding. "Although employing Medicare's policies across the board might seem easier than keeping track of multiple guidelines, using Medicare's rule for all insurers may financially hurt your business," Borden says. Therefore, with 69990 and ear surgeries, your bottom line will benefit from following individual payer rules.

Report 69990 Combo to Private Payers

For non-Medicare insurers, you should not include 69990 in the ear surgery codes. According to CPT, you may use 69990 with middle or inner ear surgery, says Karen Strickler, assistant manager/billing manager at Southeastern ENT & Sinus Center in Greensboro, N.C.

"CPT very plainly lists the procedures that have 69990 as an inclusive component," Strickler says. The list does not include middle and inner ear surgeries, she adds. Therefore, you may report 69990 in addition to ear surgeries, such as 69501 (Transmastoid antrotomy [simple mastoidectomy]), to commercial payers if the surgeon uses microsurgery techniques.

Do Not Bill OM Code to Medicare   On the other hand, Medicare and Medicaid believe that microdissection requiring OM use is inherent in [...]