September 18, 2014
One of our doctors did a tympanoplasty on the right ear and a paper patch on the left ear. These codes are bundled. Can I be paid for both procedures? If so, how do I code this?
While these codes are bundled, you are right that you should be paid for both procedures in this circumstance. Because the procedures were performed on different ears, modifier 59 should be appended to the paper patch code (the lower valued code) to indicate the separate site surgery. This would specify that the procedures were not performed on the same ear and payors will generally allow for separate payment for both. Some payers may require RT-right ear and LT-left modifiers to indicate performance of the procedure on the specific ear. Remember that multiple surgery rules will apply. You will be paid 100% of the allowed for the first procedure and 50% for the subsequent procedures performed.
ICD-10-CM codes will help to support separate services in instances like this. The diagnosis codes for some conditions will be differentiated by site. The ICD-10-CM code set will allow us to indicate specific diagnoses associated with the specific ear as shown with these examples.
H66.3X1 Other chronic suppurative otitis media, right ear
H72.01 Central preformation of tympanic membrane, right ear
H66.012 Acute suppurative otitis media with spontaneous rupture of ear drum, left ear