Forum - Questions & Answers

Feb 17th, 2019 - rdinaso    12  1 

Brand new to ENT and I have a question

Can we code 69631 and 69421 together, same ear?

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Mar 12th, 2019 - ChrisW   135  1 

re: Brand new to ENT and I have a question

Do an NCCI edit check for Medicare and other payers that follow the NCCI policy Manual and edits. You will see there is an edit stating if both codes are submitted only 69631 will be paid. The Rational behind the edit is Standards of medical/surgical practice, For further understanding look up the rules in the NCCI Policy Manual. If you are using Find-A-Code these can be found under the TOOLS section.

69631 - Tympanoplasty
69421 - Myringotomy

According to the NCCI Policy Under Chapter V111 you will find auditory systems, read section E.2.
"A myringotomy (e.g., CPT codes 69420, 69421) is included in a tympanoplasty or tympanostomy procedure and is not separately reportable".

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Mar 14th, 2019 - Mateen 1 

re: Brand new to ENT and I have a question

Yes, we can, I just check the NCCI edit, your second code 69421 requires unbundling modifier (59 or X{ESPU}). Point to be consider it that NCCI helps in finding the coding conflicts. It is developed by CMS and every MAC uses it but would commercial plans follow NCCI? It is not predictable. For safe side use NCCI rules as guideline for all plans.

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