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Coding Adenoidectomy and Tympanostomy Together

  1. #1
    Salisbury, MD
    Unhappy Coding Adenoidectomy and Tympanostomy Together
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    Okay, I need some help. Should their be a modifier attached to the 69436, other than bilateral when these are done at some surgical session?

    42830 (Adenoidectomy)
    69436-50 (bilateral Tympanostomy (requiring insertion of ventilating tube).

    Problem: EncoderPro says need modifier 51 to 69436, but these are 2 different organ systems, so wouldn't 59 be more appropriate.

    Also, if you go to CMS CCI code edits, these 2 are not listed together?

    Help. Claim is being denied when modifier 59 is being added to 69436.

    Please add rationale..Thanks

  2. #2
    no modifier is needed, except the 50 for bilateral

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