# ENT coding: nasopharyngeal mass excision via scope



## jmulis (Nov 14, 2018)

A surgeon is disputing our procedural coding on the following operation. I'd like to check our work and if correct, find some official source that may help explain to him why we've chosen the code we did. We selected 30999 unlisted procedure, nose because there is no code describing a nasal mass excision via scope....the surgeon wants us to use 30117 Excision/destruction, intranasal lesion, internal approach, which I don't think is accurate. I don't code ENT much anymore, so I may be off base and would really appreciate feedback from more experienced ENT coders.

If it matters, pathology came back as:

DIAGNOSIS
Nasopharynx, biopsy:
Nasopharyngeal mucosa with reactive lymphoid hyperplasia.

PROCEDURE PERFORMED: Removal of nasopharyngeal mass.

PROCEDURE: The patient was identified, taken back to the operating suite, placed in a supine position and administered a general endotracheal anesthetic by the department of anesthesia. After being successfully induced, I directed my attention to the nasal cavity where a 0 degree scope was used to identify the right nasal cavity. The scope was taken into the nasopharynx where a nasopharyngeal mass was noted. Using Tru biting forceps and Takahashi biting forceps the mass was removed and sent to pathology. Cauterization was done intranasally and through orally until the bleeding was controlled. The patient tolerated the procedure well and was sent to the postanesthesia recovery unit in satisfactory and stable condition. Postop instructions were discussed with the family instructions to follow up in the office in six weeks or sooner pending pathology results.


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## cgaston (Nov 14, 2018)

Since the code states intranasal, they need to get up there somehow. Are there other methods they would use?


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## jmulis (Nov 15, 2018)

That was the surgeon's point as well. He says he has to use a scope or he would have to go through the side of the nose. I see his point but just can't get past the lack of the endoscopic approach contained within the CPT code description itself. Honestly, I'm probably overthinking the whole thing.


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## hbair99 (Dec 17, 2018)

The OMFS doctors I work for just did one of these in the hospital under GA.  I can't find anything that describes going intranasally with direct endoscope to remove nasalpharyngeal mass.  I will continue to follow this Forum and let you know what I can figure out.  But I am leaning towards the unspecified code.


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## mgilbertpa@gmail.com (Feb 2, 2019)

*Marie GIlbert, PA-C Emeritus, CPMA, CENTC*

This is not an unlisted procedure.

The 0 degree scope was utilized to visualize the lesion, which was removed via instrumentation.  
30117 does not describe the procedure correctly either, as the operative note says nasopharyngeal mass, not nasal, and because 30117 isn't  under endoscopy.

I believe the correct endoscopic code is 31237.

You would use 42804 if the scope wasn't needed to find the mass.


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