Have you considered billing just 69610-50? Because the code description says with or without patch,so a patch isn't necessary to bill the code. If the doctor went in to remove tubes and repair both the holes but felt one side the repair was not needed this would be accurate coding.
However, if you feel that the doctor did less work you could always append the 52 modifier (reduced services) to the 69610-50 to recognize less work on one side. This is what I do for my doctor when this situation occurs.
Hope this helps!
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