Pediatric Coding Alert

Question: A pediatrician removes a bead from each of a child's ears without anesthesia. Should I bill for the second ear with modifier -50?

New Jersey Subscriber Answer: Code 69200 (Removal of foreign body from external auditory canal; without general anesthesia) stipulates "foreign body" singular, not plural. Therefore, you should report each removal.
 
In addition, the foreign-body removal from ear code is a unilateral code. So, you should bill for the removals per ear. To indicate, a separate site (left ear from right ear), append modifier -59 (Distinct procedural service) to the second ear procedure instead of modifier -50 (Bilateral procedure). To identify the specific ear, you also should append modifier -LT (Left side) and -RT (Right side) to 69205. For one bead in each ear, possible billing might look like this:

  69205-RT
  69205-59-LT.

Don't forget to report the pediatrician's history, examination and medical decision-making that led to the decision to remove the stones. To indicate the E/M led to the decision for surgery, you should append modifier -57 (Decision for surgery) to the office visit code (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient).