Scope Out Higher Reimbursement by Reporting Endoscopies Accurately

Allergist often use the endoscope as a diagnostic tool. To report endoscopic procedures accurately, coders must distinguish carefully among several similar CPT codes. In addition, indications must thoroughly demonstrate medical necessity, and documentation must specify the distinct nature of the endoscopic investigation to avoid bundling or downcoding of separately billable procedures. Lastly, modifiers are appropriate in some instances and will aid in gaining proper reimbursement for services provided.
A Scope Is a Scope Is a Scope?
CPT contains dozens of codes to describe endoscopic procedures. Typically, allergist bill the following three:
31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
31575 Laryngoscopy, flexible fiberoptic; diagnostic
92511 Nasopharyngoscopy with endoscope (separate procedure).
Distinguishing among these codes can be difficult because all three describe diagnostic nasal endoscopies, and the procedures defined by each may be performed using the same type of scope. Nevertheless, these procedures are distinct.
The difference between 31231, 31575 and 92511 depends on where and why the exam occurs. "If you use a scope to look at the nasopharynx [e.g., the eustachian tubes, adenoids and choanae, or the area where the pharynx and the nasal passages meet at the end of the hard palate], that's nasopharyngoscopy [92511]," says Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPT's Editorial Panel and Executive Committee. "But if the physician evaluates the entire nasal cavity, including where the sinuses drain, that's a nasal endoscopy [31231]." Note that a diagnostic nasal endoscopy may require multiple passes to examine the meatus, turbinates and openings to the sinus cavities.
Eisenberg's explanation is borne out by carrier instructions. For instance, Empire Medicare Services, the Part B carrier in New Jersey and parts of New York, states in local medical review policy EN001E00 that 31231 is appropriate "to report a diagnostic nasal endoscopy when studying the area extending from the nostrils to the posterior edge of the soft palate." The LMRP further specifies that 31231 should not be used "to report a diagnostic endoscopy of the nasopharynx" and that 92511 "should be used when studying the area extending from the posterior edge of the soft palate to the nasopharyngeal wall, including the eustachian tube openings."

Code 31575, by contrast, involves the insertion of a flexible fiberoptic scope, or nasal pharyngeal laryngoscopy (NPL), through the patient's nose or mouth to examine the interior of the larynx. This provides a better view of the upper airway than a traditional mirror exam. The allergist performs the procedure in the office or, in some cases, at a hospitalized patient's bedside.
Support Scopes With Indications
When performing endoscopic procedures, an [...]

- Published on 2002-06-01