Wiki 69210 or 69424---correction. please help

[bag4498]

I apologize, I asked this question yesterday, but I had the wrong code listed. I now have the correct code below and want to ensure someone can give me the best advice. my previous post said 69210 or 69421.



Scenario: A patient is having tubes removed under general anesthesia AND there is cerumen removed from the same ear. How do I decide which code to use? 69210 OR 69424. I know I can't use both.

 

[nsteinhauser]

Assuming the tubes are still in the ear drums, I would use the more extensive code and that would be the tube removal code 69624. The cerumen is removed on the approach to the tympanic membrane to retrieve the tubes.
Hope that helps.

 

[shantelle.black@choa.org]

Hi, i have a same day surgery case where they reported ventilating tubes removal on the LT ear (69424) and tympanic membrane repair (69610) was perform on the RT ear. Per Cpt book these codes should not be billed together? However my auditor says it can still be billed together because work was performed on different ears? Please help

 

[nsteinhauser]

Hi, i have a same day surgery case where they reported ventilating tubes removal on the LT ear (69424) and tympanic membrane repair (69610) was perform on the RT ear. Per Cpt book these codes should not be billed together? However my auditor says it can still be billed together because work was performed on different ears? Please help

Auditor is correct. There is an NCCI edit. But since these are done on opposite ears/sides, you can modify the secondary code, the 69424, with a -59 modifier to break the edit.
69610 - RT
69424 - 59 - LT
If the payer denies, send the operative note with an appeal to show that they were performed on different ears.
Hope this helps.