# Endoscopic sinus viewing



## beck627 (Jul 9, 2008)

Hi all~ My doctor performed 30520 septoplasty (90 day global), 31255 & 31267 (no global) for sinuses. Patient comes in this month and this is the exam: 

VITAL SIGNS 

Height: 63 in.   
Tobacco Use: never
Allergies reviewed - no changes
OFFICE NOTE

CHIEF COMPLAINT: Patient returns to the office today in follow up, status post nasal septoplasty, bilateral total ethmoidectomies and left maxillary sinusotomy with tissue removal. 

HISTORY OF PRESENT ILLNESS:  Patient reports ongoing "sinus headaches."  She denies any purulent rhinorrhea or fevers.  She does remind me that she has multiple types of headaches, including migraines, etc.  

She indicates that she is irrigating 2-3 times per day.  

PHYSICAL EXAMINATION:  Anterior rhinoscopy reveals clear nose and midline septum.  

The patient's sinuses were examined endoscopically.  Both ethmoid sinuses bilaterally as well as the left maxillary sinus.  The patient's sinus surgery defects are healing nicely.  There is no evidence of any infection, bleeding, etc.  

IMPRESSION:
      1)  Satisfactory postoperative course. 

RECOMMENDATIONS:
      1)  Patient will continue to irrigate at least two times per day.  We have asked her to return to see us on the three-month anniversary to surgery, some time in late July.  

PROCEDURE NOTE

PROCEDURE: Nasal/sinus endoscopy; bilateral ethmoid and left maxillary sinus endoscopy.


SURGEON:  

ANESTHESIA:  Topical Lidocaine.  

COMPLICATIONS:  None.  

ESTIMATED BLOOD LOSS:  Zero.  

FINDINGS:  Included .

PROCEDURE:  Following adequate Lidocaine spray analgesia, the patient's nasal cavities bilaterally, as well as ethmoid cavities bilaterally and left maxillary sinus carefully inspected using the fiberoptic endoscope.  The above findings were noted.  

Patient tolerated the procedure well.  There were no complications.

I thought we should only bill 31233-79-50 and link sinus dx and 99024 and link dx for septoplasty because there is a component of E/M factored in to the 31233 code. 
He says that his academy fought for the codes 31255 & 31267 to not have a global and this essentially leaves him as having a global period because he can't bill a 992_ _-24 on this visit. I feel the documentation does not support a separate & identifiable E/M service. 
What do you think? All help is appreciated, Thanks!


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## Lisa Bledsoe (Jul 10, 2008)

Unless I missed something in the note, it sounds like post-op care so how is mod -79 justified?


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## Treetoad (Jul 10, 2008)

In his impression, the provider states "satisfactory post operative course".  To me, this would signal a global service.


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## mbort (Jul 10, 2008)

If I read it correctly, there was a procedure performed in the office...which would justify the need for the modifier on the procedure code.  I would use 78 instead of 79 though.


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## dmaec (Jul 10, 2008)

it appears to me, to be a postop follow-up - period, no office charge.  in my opinion it should be modifier .58 on the procedure.


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## Lisa Bledsoe (Jul 10, 2008)

Ok - I have re-read the original post and am re-thinking this situation.  Because 31255 and 31267 do not have global days but 30520 does, it kind of makes this a difficult scenario.  So you have a post-op visit for 30520 and you have the endoscopy 31233-50.  I think the problem is getting the endoscopy past the global of 30520...  It looks like the only thing you can do is use modifier -79 as unrelated to the septoplasty, since that is the only code from the original 3 procedures that has a global attached to it.  I don't think you can bill an office visit though if the endoscopy was planned.  Does that make any sense?


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## mbort (Jul 10, 2008)

Very well put Lisa, I agree


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## dmaec (Jul 10, 2008)

so, the endoscopy was done as a follow up to two procedures that don't have a global (31255/31267)?  it wasn't done as part of the followup for the septo (30520) AND the other procedures?

and yes, what Lisa says makes great sense - but, still - the endo wasn't done as follow up to "all" the procedures the patient had done?


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## Candice_Fenildo (Jul 10, 2008)

Hello all, our practice physicians perform 31233 and or 31237 as follow up after a FESS. 31256-31267 and 30520. you need to link the dx code of 473.XX to the 31233 or 31237 with mod -79. 

this is stated on the AAOHNS website. He gets credit for the procedure but NOT the E/M as well


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## beck627 (Jul 10, 2008)

Wow! I am so happy so many of you responded to this. Thank you so much for lending your expertise. It is very much appreciated!


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## Treetoad (Jul 10, 2008)

I guess that's what makes this such a great place...........what we don't know, we can certainly learn from our peers.


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