Wiki 69620 and 69436

[hthr.santos]

With 69436 being a column 2 code for 69620, would it be appropriate to add modifier XU or 59 to 69436? TIA

Once an adequate level of anesthesia was achieved, the patient's head was turned and the left ear was examined using the operating microscope and cerumen was cleaned with a cerumen curette. The tympanic membrane was well visualized a 20-25% marginal inferior anterior perforation was identified at the site of Q tip injury. The tube was medialized in the middle ear space. The tube was removed and the perforation edges were freshened at the tube site. Merogel was packed in the middle ear space to the level of the tympanic membrane and hydrated with saline. A new Touma tube was placed in the anterior aspect of the perforation. The epidisc was cut with a notch for the tube and placed in overlay fashion over the perforation. MeroGel was placed over this and hydrated with saline solution.

 

[jackjones62]

You know what, why not, I would bill 69620 and then 69436-59, if this is a commercial carrier they don't always recognize the "X" modifiers. This was more than just the TM repair so again, why not, it either gets paid or it's denied as bundled but I don't feel it would be inappropriate as the CCI edits do indicate a modifier can bypass. Go for it!

 

[Shweta]

With 69436 being a column 2 code for 69620, would it be appropriate to add modifier XU or 59 to 69436? TIA

Once an adequate level of anesthesia was achieved, the patient's head was turned and the left ear was examined using the operating microscope and cerumen was cleaned with a cerumen curette. The tympanic membrane was well visualized a 20-25% marginal inferior anterior perforation was identified at the site of Q tip injury. The tube was medialized in the middle ear space. The tube was removed and the perforation edges were freshened at the tube site. Merogel was packed in the middle ear space to the level of the tympanic membrane and hydrated with saline. A new Touma tube was placed in the anterior aspect of the perforation. The epidisc was cut with a notch for the tube and placed in overlay fashion over the perforation. MeroGel was placed over this and hydrated with saline solution.

Hi, Code 69620 for Myringoplasty is only reported if tissue graft is harvested and edges prepared for the drum defect repair. From above documentation, this appears to be 69610 (Epidisc was used as a patch to the drum defect). 69436 bundles with 69610 too. So, I think only 69610 should be reported in this case.

 

[jackjones62]

Hi, Code 69620 for Myringoplasty is only reported if tissue graft is harvested and edges prepared for the drum defect repair. From above documentation, this appears to be 69610 (Epidisc was used as a patch to the drum defect). 69436 bundles with 69610 too. So, I think only 69610 should be reported in this case.

You are correct, my oversight between 69620 and 69610. CPT 69610 is correct as no graft was used BUT they still can bill 69436 with Mod. 59 as not only did they repair the TM, they removed a tube and replaced it. As I stated in my initial response, there is more work done here than just repair the TM and CCI allows 1 modifier to bypass this edit. Coding is gray and if you can justify your point you should not short change your providers in getting paid for all the work they perform.