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Tubes Placed in Office and complications

dcarr

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This is a Medicare patient who had bilateral tympanostomy tubes placed due to otitis media with effusion on 08/07/08 in office. Patient returned 08/11/08 with obstructed tubes. Both ears were suctioned and the RT tube removed and replaced with another brand. On 8/13/8 patient returned again with thick mucoid fluid covering tubes and both ears were suctioned. All this was done in the office. My question is what is billable considering Medicare's rule about complications requiring a return trip to the OR. The OR never happend because all was done in office. Would the suctioning of the ears be considered all part of the post operative care? Also physician didn't document that he used an otoscope to remove mucous/cerumen but wants to bill 69210 on both 08/11 and 08/13. Any advice is greatly appreciated.:confused:
 

Treetoad

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As of 2008, CPT has updated the description of modifier 78 to include "unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period". Would this help you at all?
 

dcarr

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Yes, I'm aware of that and WPS, our MAC, defines an OR as not including a patient's room, a minor treatment room, a recovery room, or an intensive care unit. The service performed in a patient's room that isn't specifically equipped for the sole purpose of performing procedures.
 
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