# Nasal Endoscopy Rejection



## ksarith9@gmail.com (Jan 23, 2016)

I am Sarith Kalikkot working as a ENT Coder in Middle East, I am getting rejection for Nasal Endoscopy Procedure for past few months.


DIAGNOSTIC ENDOSCOPIC REPORT
 Thickening of mucosal lining of nasal cavity, pale in appearance with moderate congestion.
 Moderate hypertrophied L inferior turbinate with moderate congestion and oedema.
 Oedema of O.M.C. with yellowish mucoid secretion filling the middle meatus.
 Mild hypertrophied and hyperemic middle and superior turbinate more on the L side.
 No polypi, no masses, no ulceration.
 Picture of CHRONIC SINUSITIS

this is the Nasal Endoscopic report submitted by Dr, can anyone  please advice me
How many times we can bill Nasal Endoscopy for a patient?
What are the findings we have to put in Endoscopic Report?

Please help me, i am waiting for your kind help
Thanks in advance
Sarith Kalikkot CPC-A


----------



## mitchellde (Jan 23, 2016)

What codes did you submit and what was the denial reason given?


----------



## ksarith9@gmail.com (Jan 23, 2016)

CPT: 31231,rejected with MNEC: medical necessity

ICD-9
473.9
478.0
477.9

SARITH KALIKKOT CPC-A


----------



## mitchellde (Jan 23, 2016)

What was the date of service?


----------



## ksarith9@gmail.com (Jan 23, 2016)

From August-2015 to current.
UAE still we are in ICD-9 ,from January 2017 ICD-10 implemented


SARITH KALIKKOT CPC-A


----------



## mitchellde (Jan 23, 2016)

ICD-10 is different from ICD-10 CM.  if you are billing to US payers you are required to submit claims with ICD-10 CM codes for DOS Oct 1, 2015 and forward.  Also many payer will not accept unspecified codes especially with a diagnostic test.  The interpretation needs to be specific to location.  I saw no documentation of allergic rhinitis for this case.


----------



## ksarith9@gmail.com (Jan 23, 2016)

mitchellde said:


> ICD-10 is different from ICD-10 CM.  if you are billing to US payers you are required to submit claims with ICD-10 CM codes for DOS Oct 1, 2015 and forward.  Also many payer will not accept unspecified codes especially with a diagnostic test.  The interpretation needs to be specific to location.  I saw no documentation of allergic rhinitis for this case.



We are still in ICD-9 CM, and we are not billing to US payers also,Allergic Rhinitis Dr can justify with ROS and patient presenting symptoms,they only rejected Nasal Endoscopy,
my question is
1. How many times we can bill nasal endoscopy for a patient?
2. Report Submitted by my Dr. is sufficient?

Thanks

Sarith Kalikkot CPC-A


----------



## ljones88 (Feb 17, 2016)

Sarith, 

We have templates built within our EMR system to help the physicians complete a full report. For complete documentation of a procedure report we ask that they include the following documentation when performing a fiberoptic and/or nasal endoscopy. We also ask that they state either within the physical exam or in the indication section the reason why the nasal endoscopy was medically necessary (i.e. indirect exam findings warranted further direct exam by scope, or gag reflex makes indirect exam impossible, etc.)

Procedure
Procedure note (areas viewed; procedure in detail)
Indication for the procedure
Findings upon review
Topical agents used
Patient status
Complications


Many payers have internal edits in place to capture claims being submitted by physicians that may alert them to over billing. For example, Humana has an edit in place for 69210 billed with any established E/M. If the claim comes in from our group with these two codes and they see in the patient's claim history that 69210 was billed less than 6 months ago, they deny the claim for medical necessity and we have to submit a reconsideration with medical notes. It seems as though your payer may be invoking a similar edit.....It's an automatic way to basically request medical notes, in my opinion. Usually once the notes are submitted the claims get paid. I've rarely had to submit a formal appeal on that specific 69210 issue.


----------

