tci Outpatient Facility Coding Alert - 2014 Issue 3

Reader Question: Look to 69799 for Sedation During Ear Tube Insertion

Question:  Our physician removed a patient’s ear tubes in an ASC setting under MAC anesthesia (instead of general). If he either inserts or removes tubes under these circumstances, can we report 69424 with modifier 52 instead of submitting the unlisted procedure code? New York Subscriber Answer:  A quick glance shows that 69424 (Ventilating tube removal requiring general anesthesia) applies to procedures involving general anesthesia. If you report the code with modifier 52 (Reduced services), the payer will expect to see documentation that the surgeon performed less than the procedure represented by the code, not a different...

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