Otolaryngology Coding Alert

Endoscopy of patient with existing sinusostomy counts as 31231, AAO says Not sure if you should use 31233 and/or 31235 when the patient already has windows? Stick with 31231. Experts have recommended that otolaryngologists could report maxillary or sphenoid sinusoscopy without performing the puncture at the same session. But a recent bulletin from the American Academy of Otolaryngology -- Head and Neck Surgery (AAO-HNS) puts an end to that option. After numerous inquiries on the requirements of 31233 (Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy [via inferior meatus or canine fossa puncture]) and 31235 (Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy [via puncture of sphenoidal face or cannulation of ostium]), the AAO-HNS gave definitive answers on these codes- requirements. Here's what you need to grasp. Realize Experts Thought -Or- Language Implied 2 Techniques Coders and associations alike pointed to the inclusion of "or" in CPT's 31233 descriptor to support the now-outdated rationale that you could use sinusoscopy code 31233 without performing a puncture. Code 31233 "describes the same procedure accomplished by two distinct techniques: via inferior meatus OR canine fossa," says the American Association of Ambulatory Surgery Centers (AAASC) in a January 2005 letter to CMS. Technique 1 was: "In the former instance, the surgeon explores the sinus by threading an endoscope through the nasal passages. This is a relatively painless procedure that is easily furnished in the office setting," according to the AAASC letter. Technique 2, now the only appropriate method, according to the AAO-HNS, is: The latter technique, however, involves exploring the sinus by jamming a trocar through the roof of the patient's mouth, and inserting an endoscope through the new cavity. This latter procedure is very painful and would almost never be performed without sedation, which can only be safely administered in a facility setting." The key in selecting 31233 was that the otolaryngologist had to explore the maxillary. "Consultants reasoned that if the patient had windows from a prior surgery that allowed the surgeon access through the inferior meatus, otolaryngologists could consider this appropriate use of 31233," says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders based in Salt Lake City. Understand 31235 In-Office Was Never Debated You could previously have interpreted the "or" in 31235's parenthesis "via puncture of sphenoidal face or cannulation of ostium" to support coding a sphenoid sinusoscopy without puncture. But because patients are rarely open into the sphenoids and otolaryngologists do not often examine them in the office diagnostically, this rationale was not really debated or applicable. In addition, otolaryngologists infrequently use this code. Reserve 31233, 31235 for Same-Session Puncture But an insurance carrier that disallowed 31233 in the office caused one [...]