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Otolaryngology Coding Alert

Reader Question:

Is 69205-50 Appropriate?

Question: An otolaryngologist removes a foreign body from both ears under anesthesia. Should I bill the procedure code bilaterally? New York SubscriberAnswer: To determine whether the code is eligible for bilateral billing, you should look up the foreign-body removal code in the National Physician Fee Schedule Relative Value File. Column "Z" will give you the answer. If the column contains a:0 -- the code is not eligible for bilateral billing due to anatomy or the code's description1 -- you may bill the code bilaterally 2 -- the code already includes bilateral payment3 -- Medicare does not subject the code (which you bill bilaterally) to bilateral payment adjustments 9 -- the concept does not apply.Column Z of the Fee Schedule lists a "0" for 69205 (Removal foreign body from external auditory canal; with general anesthesia). Therefore, you should not bill 69205 bilaterally with modifier 50 (Bilateral procedure).Right way: You should instead use modifier 59 (Distinct procedural [...]