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ENT Adenoidectomy/tympanostomy

  1. #1
    Salisbury, MD
    Default ENT Adenoidectomy/tympanostomy
    Medical Coding Books
    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. 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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