Otolaryngology Coding Alert

You can report 31237 as a post-op procedure

If denials and quickly advised -don-ts- are making you reluctant to code for postoperative endoscopic debridement, gain the confidence to use 31237 by pinpointing the initial surgery and the postprocedure's reason.

Which Surgery Did the ENT Initially Perform?

An otolaryngologist may perform postoperative debridements (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) for sinusitis after functional endoscopic sinus surgery (FESS, 31254-31294), which may also include septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and/or turbinectomy (30130, Excision inferior turbinate, partial or complete, any method, or 30140, Submucous resection inferior turbinate, partial or complete, any method).

Before you can determine if you should report the debridement, you must identify the primary surgery.

Why: The Medicare Physician Fee Schedule assigns different global periods to 30520, 30130-30140 and FESS codes. Codes 30520 and 30130-30140 have 90-day global periods. But FESS codes contain zero global days. Different global periods equate to two coding scenarios.

Scenario 1: The otolaryngologist performs debridement after sinus surgery. Because FESS codes have zero global days, you can bill the debridement after endoscopic sinus surgery with 31237, says James A. Stankiewicz, MD, with Loyola University Medical Center, department of otolaryngology, in Maywood, Ill. -The chart needs to have appropriate documentation that endoscopic debridement was performed and was the focus of the visit,- according to Stankiewicz's article -Management After Sinus Surgery- in the American Rhinologic Society's (ARS) July 1999 newsletter.

Tip: Challenge payers that allege to follow Medicare's resource-based relative value scale but bundle the debridement as included in an insurer-created FESS package. CMS -assigned payment values for FESS assuming that medically necessary subsequent diagnostic endoscopies (CPT code 31231) or surgical endoscopies with debridement (CPT code 31237) would be reimbursed separately as outside the zero-day global period,- writes Joseph B. Jacobs, MD, New York University Medical Center in New York City in a March 2000 ARS Socioeconomic Update.

Scenario 2: But when your otolaryngologist performs a debridement within 90 days after septoplasty and/or turbinectomy with or without FESS, the debridement falls within 30520's and/or 30130-30140's global surgical periods. Billing the debridement hinges on the answer to another question.

Why Did the ENT Perform Debridement?

Next, you need to focus on what the physician is debriding and why after performing a septoplasty and/or turbinectomy with or without FESS.

Unrelated to septo/turb: When the otolaryngologist performs debridement for a reason that is unrelated to why she worked on the septum and/or turbinates, you should bill for the debridement. Append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 31237 to indicate that the debridement is unrelated to the postoperative period, says Ginny McManus, billing manager at BergerHenry ENT Specialty Group in New Jersey.

Modifier 79 can save you from appeals hassles. At BergerHenry ENT, McManus usually bills post-op FESS-related debridement with 31237-79 and 473.0 (Maxillary sinusitis). -We have not encountered any insurance nonpayment issues to date,- she says.

Code 31237 is a unilateral code, so you should bill 31237 or 31237-50, -depending on whether the surgery

was unilateral or bilateral,- McManus says.

Related: But if the debridement is related to the septoplasty/turbinectomy, you should include the related care in the surgery package. -We do not bill 31237 for [postoperative] septo or turbinates, even though the turbinates may require debridement at times,- McManus says. The ENT has already been paid for the post-op visits related to the septo and/or turb procedures because 30520 and/or 30130-30140's surgical fees include debridements.

Documentation should reflect that the debridement is unrelated to the reason that the otolaryngologist worked on the septum and or turbinates, and it should show medical necessity for the debridement.

Example: After a septoplasty for a deviated septum, a turbinectomy for hypertrophy, a total ethmoidectomy for ethmoidal sinusitis (473.2) and a maxillectomy for maxillary sinusitis (473.0), an otolaryngologist performs debridement. Documentation indicates the debridement was to remove the crusting that occurs following sinus surgery, to prevent infection and to keep the airway patent.

Because the ENT performs the debridement for a reason (chronic ethmoidal and maxillary sinusitis) that is unrelated to the reason for the septoplasty and/or turbinectomy, you should report the debridement.

Append modifier 79 to 31237, and include a note that -the debridement is unrelated to procedures 30520 and/or 30130-30140, diagnosis 470 (Deviated nasal septum) and 478.0 (Hypertrophy of nasal turbinates) on date of surgery xx/xx/xxxx.-