Answer: Look at the graft's location. You should only bill for harvesting a graft from an ear other than the one receiving the graft. If the otolaryngologist harvests a graft from the right ear for placement on the right ear during a myringoplasty, include the graft in 69620 (Myringoplasty [surgery confined to drumhead and donor area]). But if the surgeon has to go to the other ear to obtain the graft, you should report 20926 (Tissue grafts, other [e.g., paratenon, fat dermis]) in addition to 69620. That's right, the claim should contain 69620 and 20926 with no modifiers. You should not attach a modifier to 20926 because CPT designates 20926 as exempt from modifier 51 (Multiple procedures). This status does not make 20926 an add-on code, but it exempts the graft from the multiple-procedure discount.