Ensure Payment:Match Approved Diagnoses to Scopes

Establishing medical necessity for endoscopic procedures depends largely on the attending diagnosis(es). Medicare carriers and other payers specify varying guidelines as to the diagnoses they will accept to support 31231, 31575 and 92511, but the following represents a typical (although incomplete) list of commonly accepted ICD-9 codes for each:
31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
461.0-461.9 Acute sinusitis
471.0-471.8 Nasal polyps
473.0-473.9 Chronic sinusitis
476.0 Chronic laryngitis
478.0-478.29 Other diseases of upper respiratory tract
493.90-493.91 Asthma, unspecified (atypical)
780.50-780.57 Sleep disturbances
784.40-784.49 Voice disturbance
784.7 Epistaxis
784.9 Other symptoms involving head and neck
786.2 Cough
31575 Laryngoscopy, flexible fiberoptic; diagnostic
464.4 Croup
465.0 Acute laryngopharyngitis
472.1 Chronic pharyngitis
478.70-478.79 Other diseases of larynx
491.1 Mucopurulent chronic bronchitis
518.81 Respiratory failure
519.1 Other diseases of trachea and bronchus
780.51 Insomnia with sleep apnea
784.1 Throat pain
784.2 Swelling, mass, or lump in head and neck
784.49 Other voice disturbance
989.5 Toxic effect of venom
995.0 Other anaphylactic shock
92511 Nasopharyngoscopy with endoscope
478.0-478.29 Other diseases of upper respiratory tract
780.6 Fever
781.1 Disturbances of sensation of smell and taste
782.2 Localized superficial swelling, mass, or lump
784.1 Throat pain
784.7 Epistaxis
784.9 Other symptoms involving head and neck
786.3 Hemoptysis
787.2 Dysphagia
Contact your individual insurer or visit www.lmrp.net for a complete list of diagnoses acceptable to Medicare Part B carriers. Note that some insurers will allow a diagnosis that does not appear in their local medical review policies and may give individual consideration to unlisted diagnoses in certain circumstances.

- Published on 2002-06-01