Otolaryngology Coding Alert

You have 3 tools to relate look-see, E/M to FESS.

If endoscopy and office visit denials during a septoplasty's global period plague you, a modifier could fix the condition.

In Otolaryngology Coding Alert Vol. 11, No. 9, you coded a chart note that documented a planned scope (31231, Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) following septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft), bilateral total ethmoidectomies (31255-50, Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior] -; Bilateral procedure) and maxillectomy with tissue removal (31267, Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus).

The first half of the article "Bust 2 Myths That Could Make You Leave Post-Op Scope Dollars on the Table" addresses reporting only the look-see due to the physician performing no separate E/M. To put the claim on the path to proper payment,check these FAQs.

Question: Do I need modifier 50 on the scope code?

"Unlike all other sinus endoscopy codes, the code description for 31231 indicates -unilateral or bilateral,-" says Lynne Fitzpatrick, MA, CPC-GENSG, health record analyst for Surgery and Trauma Specialists of Maine at Eastern Maine Medical Center in Bangor.

"Therefore, it wouldn't be appropriate to charge 31231 with modifier 50 (Bilateral procedure)." The code's allowance already includes both sides.

Modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) is correct, says Michelle Logsdon, CPC, CCS-P, PCS, at Falcon Practice Management in Toms River, N.J. The septoplasty has the global period -- 90 days -- and the scope is related to the sinus headaches, not the septoplasty.

Caution: Don't assume you can automatically bill 31231-79 in every post-septo case. "Medical necessity dictates whether or not to charge for the scope," Fitzpatrick notes. If the ENT performed the scope to merely check the healing status of the septoplasty, include the scope as part of 30520's global surgical package.

Although there is no global period for the sinus surgeries (bilateral total ethmoidectomy, 31255-50; and maxillectomy with tissue removal, 31267), insurance companies always deny 31231 or an E/M code based on the septum global days, reports Ginny McManus, billing manager at BergerHenry ENT Specialty Group in New Jersey.

Show insurers the scope or E/M are unrelated to the global period employing these three tips:

1. Put modifier 24 (Unrelated evaluation and management service by the same physician during the global period) on the office visit code (99212-99215, Office or other outpatient visit ...) to indicate the E/M is unrelated to the existing global period.

2. Link the documented non-septum diagnoses, such as headache (346.10, Migraine without aura ...) and sinusitis (473.0, Chronic sinusitis; maxillary; and 473.2, Chronic sinusitis; ethmoidal) to 31231-79 to show the endoscopy is related to the headache and sinus surgeries.

3. Make sure the documentation that you are basing your E/M level on totally carves out any septum care of findings and is relates only to the headaches.

Be prepared to fight for payment. "We always have to appeal even if we have a different diagnosis and a 24 modifier on the E/M," McManus adds.