Wiki Myringoplasty and tympanoplasty

[AN2114]

I have an op report and the procedure that was done is an "excision of right tympanic membrane and middle ear cholesteatoma with right gelfoam myringoplasty and then left gelfoam myringoplasty/repair of tympanic membrane perforation." From what I've researched, it looks like the code for the exicision of right tympanic membrane and middle ear cholesteatoma is code 69631. And the gelfoam myringoplasty I know is code 69610. According to NCCI Edits I cannot code 69610 and 69631 together so does anyone know is 69610 included in 69631 or if it's the other way around? Or should I code 69631-RT and 69610-LT?

Thanks!

 

[nsteinhauser]

If they are performed on different ears, you can code them separately with the -RT and -LT. Depending on the payer, you would add a -59 to the second line.
Hope this helps.

 

[AN2114]

If they are performed on different ears, you can code them separately with the -RT and -LT. Depending on the payer, you would add a -59 to the second line.
Hope this helps.

Thank you! The excision of the cholesteatoma was only done on the right ear but the myringoplasty was done on both ears so that is whats confusing me if the myringoplasty is included in the tympanoplasty and just code them separate or only code the myringoplasty code bilateral.

 

[b.cobuzzi]

I would code:

69631-RT
69610-59-LT (or XS for Medicare Part B or any payer like United Healthcare that recognizes the “X” modifiers for separate procedures since use of the “X” modifiers shows the payer you checked and are sure that you are using the separate procedure properly, and for the correct reason)

The reason I would code it this way is that you would be optimizing your RVUs and income based on what was actually performed. You cannot code for the myringoplasty on the right side since the 69631 is also performed on that side.

 

[AN2114]

I would code:

69631-RT
69610-59-LT (or XS for Medicare Part B or any payer like United Healthcare that recognizes the “X” modifiers for separate procedures since use of the “X” modifiers shows the payer you checked and are sure that you are using the separate procedure properly, and for the correct reason)

The reason I would code it this way is that you would be optimizing your RVUs and income based on what was actually performed. You cannot code for the myringoplasty on the right side since the 69631 is also performed on that side.

Thank you!