# Nasal endoscopy with bronchoscopy - My 4 year-old had to have a



## venetziamadison@yahoo.com (Jan 2, 2012)

My 4 year-old had to have a laryngoscopy/bronchoscopy the day before I took the CPC exam. When I received the bill they had coded 31231 and 31622 for the procedure, which I found strange. Since the nasal endoscopy is an integral part of the bronchoscopy procedure I didn't think it is separately coded. There was not a separate sinus exploration, and the billing department lady told me that the sinus endoscopy code was there because that's how they got in. Even after that explanation it doesn't sit well with me, and since I'm still learning I figured it would be a good idea to ask the pros. Thanks!


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## RonMcK3 (Jan 2, 2012)

*It's okay per NCCI*

According to the CCI, 31231 can be billed with 31622 if a modifier is used. (effective 7/1/2003)

Hope this helps,


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## mitchellde (Jan 2, 2012)

CCi edits call the 31231 a component of the 31622 because you are correct you cannot bill the approach when a more definitive procedure is performed via that approach.  Just because you are allowed to modify the pair does not mean you CAN modify given the documentation.  To unbundle this there must be something to support it such as a separate session an intervention in between the two procedures to show why they are two distinct parts not just one procedure consisting of an approach and a procedure.
If what you say is true I would definitely fight this and request a copy of the procedure note to show two distinct procedures being done


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## venetziamadison@yahoo.com (Jan 2, 2012)

*Thanks!*

Thank you! I will give them a call and ask for the notes. I am not concerned with the bill as much as what I can learn from this. Your input is very much appreciated.

Venetzia Madison


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## lzoolalian (Jan 3, 2012)

*Nasal endoscopy vs Laryn/Broncoscopy endoscopy*

"For endoscopy procedure, code approprite endoscopy, of each anatomical site examined."CPT 2011, pg. 112.

    I'm not sure what the principal diagnosis is for your son, and I hope he is feeling better. And I am probably incorrect, but isn't the physician evaluating 3 different anatomical sites. The sinuses, the larynx, and the bronchi? 

31231- Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
"for diagnostic evaluation refer to employing a nasal/sinus endoscope to inspect the interior of the nasal cavity and the middle and superior meatus, the turbinates, and the speno-ethmoid recess." CPT 2011, pg,109 
Could this mean that the physician went up the nose, into the paranasal sinuses to look and inspect the first anatomical site:   the Frontal sinsuses:  1. Frontal sinus,  2. the Ethmoid sinus,  3. the sphenoid sinus and it's recess. 4. the Ethmoid/Sphenoid turbinates and meatus.  These are all cavities or small spaces in the face behind the skin, below and next to the brain and eyeballs.

 After this evaluation, the doctor would then pull the scope back and then procede down the nasopharynx, pass the epiglottis to the larynx and inspect this area also.  The physician would then take the scope and pass the larynx to the trachea, then into the second anatomical site:  the Lung cavity, into either the right or left bronchus?

31622-Bronchoscopy, rigid (not through the nose- but through the mouth) or flexible,(through the mouth or nose), including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed etc.CPT 2011, pg.112

To me it seems as though the physician at the time of surgery could have evaluated at least 3 or more different anatomical sites.  I think this is what you need to see and ask about from the intra/post operative surgical notes.
I hope this helps.


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## losborn (Jan 3, 2012)

*Interesting question...*

CPT states that the appropriate endoscopy should be coded for each anatomical site examined (just above code 31615).  However, office staff said they coded it because that was the approach, not that this area was examinied - which means it is NOT billable.  Perhaps the Dx would be important to know to see if it supports a separate sinus Px.  Say that the doc excised a nasel polyp, and then proceded to Bx a lung mass; that would, I should think, qualify as -59 appropriate.

Lin


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