Question 69705/69706 Misuse of column 2 ?

vibyers

New
Messages
1
Best answers
0
With the new ETD Balloon Dilatation code 69705/69706 we are getting denials when we are preforming 69436 Tympanostomy at the same time on the same side. NCCI is stating: Misuse of column two code with column one code. (Provider must have performed all of the services noted in the descriptor unless the descriptor states otherwise. (Occasionally, a HCPCS/CPT code descriptor will identify certain services that may or may not be included.) A HCPCS/CPT code should not be reported out of the context for which it was intended.)

The issue that I have is that the approaches are different. With 69705/69706 we are going through the nasal/sinus passages and the 69436 we have a external approach through the ear canal.

Can some one help explain this better?
 

wynonna

Expert
Messages
353
Location
Hinsdale, MA
Best answers
0
We have been using 69436 as primary procedure.
We have been adding 69705/69706 for secondary procedure when done with -79 modifier. Dx for 69705/69706 we use "Eustachian tube dysfunction"
 

nsteinhauser

Expert
Messages
346
Best answers
0
-79 reads: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
I'm assuming these are performed during the same surgical session? If so, -79 wouldn't apply because the 69705/67906 was not performed in the 'Postoperative Period.'
Thank you.
 
Messages
25
Best answers
0
We also billed 69706/59 with 69436/5950 and have been denied by BCBSIL any suggestions would be appreciated. I read edits and a modifier is allowed if I understood correctly.

We billed
69631/LT
69706/59
21235/59
69436/5950
ALL but 69706 were pd, denied as inclusive.
 
Last edited:

trarut

True Blue
Messages
594
Location
Columbus, OH
Best answers
0
Ran the codes through the CCI tool in Codify and I agree that -59 modifier can be used with 69706 when appropriate. Personally, I would look for a policy from BCBSIL, probably a reimbursement policy of some kind, that might explain the bundling denial. You may just need to appeal with medical records.
 
Messages
25
Best answers
0
Ran the codes through the CCI tool in Codify and I agree that -59 modifier can be used with 69706 when appropriate. Personally, I would look for a policy from BCBSIL, probably a reimbursement policy of some kind, that might explain the bundling denial. You may just need to appeal with medical records.
Thank you
 
Top