# What needs to be done for 31231?



## lindsayroper

The CPT codebook states 31231 "inspects the interior of the nasal cavity and the middle and superior meatus, the turbinates and the spheno-ethmoid recess."   
Do all these structures need to be documented in the chart note in order to use 31231?  What if the Dr scoped the turbinates and the superior meatus, but didn't document he looked at the middle meatus or the spheno-ethmoid recess? Can 31231 still be used?


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## Candice_Fenildo

If the doctor CAN view only those areas with a nasal speculum and not have to use the sinus endoscope, then it would not be appropriate to use the nasal endoscopy. 

most MAC's have Guidelines and LCD's on CPT code 31231. here is an excerpt. 

A diagnostic nasal endoscopic examination permits visualization of upper airway structures inaccessible to the conventional otoscope or nasal speculum. The endoscopic examination is a safe and rapid (10-15 minutes) procedure used to diagnose nasal and/or sinus pathologic conditions and is performed with a rigid nasal endoscope and/or a flexible endoscope. A nasopharynx examination inspects the posterior naspharyngeal wall, posterior choanae, fossa of Rosenmueller, eustachian tube orifices, and the superior aspect of the soft palate. The nasal/sinus examination involves the inspection of the above mentioned areas in addition to the spheno-ethnoidal recess.


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## lindsayroper

Thanks for the reply, but that doesn't answer my question. 
I don't need to know the indications for the use of a scope. I need to know what anatomical structures need to be documented/visualized in order for the scope itself to be billed.  
For example, if the Dr documents that he uses the scope to look at the middle meatus (and nothing else) - is this what qualifies for the use of the scope? OR does the Dr have to document/visualize the middle meatus, turbinates, nasal cavity, spheno-eth recess (all the structures listed in the CPT book for this code) in order for the 31231 to be properly billed?


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## Candice_Fenildo

Position Statement from the American Rhinological Association:  If this does not help you then I apologize. 


Diagnostic nasal endoscopy is a procedure performed to better  characterize the anatomy of the nasal cavity and/or paranasal sinuses  and to identify sinonasal pathology *not afforded by anterior rhinoscopy*.  It is typically performed in the office setting using rigid or flexible  endoscopes, often, but not always with topical decongestion and/or  anesthesia, though can be performed in the operating room as well. Many  practitioners often also utilize a video monitor and a recording device  for  documentation and education purposes.

*Common indications for diagnostic nasal endoscopy include but are not limited to:*


Evaluate for chronic sinonasal symptoms unexplained by anterior rhinoscopy
Assess interval response to medical or surgical therapy in patients with chronic sinusitis and recurrent acute sinusitis
Monitor for recurrence of nasal polyps
Evaluate and manage epistaxis
Perform endoscopically guided cultures
Assess facial pain suggestive of rhinogenic origin
Evaluate clear rhinorrhea suggestive of cerebrospinal fluid leak
Perform initial diagnosis and interval surveillance for sinonasal neoplasms


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