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Thread: ENT Adenoidectomy/tympanostomy

  1. #1
    Join Date
    Apr 2007
    Salisbury, MD

    Default ENT Adenoidectomy/tympanostomy

    AAPC: Back to School
    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

    Wink Ent...

    Hi Lynn,

    Wondering who the payer is...sometimes that makes a world of difference.

    I agree that the -59 modifier is the way to go (since MOST carriers refuse to acknowledge of accept -50). If you received a denial, my best advise is to submit a paper appeal with the op report showing that both the right and left ears were involved.

    The other consideration of course would be to submit the claim with -RT and -LT modifiers...again, depends on the payer.

    If it wasn't for the high amount of denials issued DAILY, what else would the insurance companies have to do? Oh yeah, pay our claims!

    Coding/billing is like sailing on the Titanic...though sometimes I think that would have been more comfortable...yikes.

    Hope this was of a little bit of help at least.

    Have a great weekend.


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