Otolaryngology Coding Alert

2 tips make all the difference in your reimbursement for these services.

When an ENT completes fiberoptic nasal sinus endoscopy, nasopharygoscopy and / or fiberoptic laryngoscopy on the same date of service, you should bundle these services and report only one code -- or append a modifier to override the edit in very rare instances. Otherwise, you'd be at risk of getting a denial. The code you should report is a function of the diagnosis which drives the medical necessity for the diagnostic test.

Check out these two tips to get you started on the right track.

Tip 1: Think Twice Before When Using Modifier 59 For 31231, 31575 Edits

The National Correct Coding Initiative has bundled nasal sinus endoscopy (31231, Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) into flexible fiberoptic laryngoscopy (31575, Laryngoscopy, flexible fiberoptic; diagnostic) effective July 1, 2003. This means you cannot bill 31231 and 31575 together unless you append an allowable modifier to 31231 to override the edit if and only if modifier 59 (Distinct procedural service) is applicable to the situation and documentation. In this case, you should use modifier 59 (Distinct procedural service) rather than modifier 51 (Multiple procedures).

However, keep in mind that when these edits were created, the premise that the laryngoscopy and the nasal endoscopy are performed at different sites was built into the bundle since a nasal endoscopy and a laryngoscopy are always performed on different sites based on their descriptions and therefore, using the modifier 59 because the scopes examined different sites is inappropriate, warns Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J.

The only appropriate use for modifier 59 would be if the physician performed the two different scopes at different encounters, for example, a nasal endoscopy in the office in the morning and a laryngoscopy in the ER later that evening. The same rules apply to 92511 (Nasopharyngoscopy with endoscope [separate procedure]), which is also bundled per NCCI with 31231 and 31575. You may check out the article on the American Academy of Otolaryngology/Head and Neck Surgeons web site (www.entnet.org/Practice/Reporting-Nasal-Endoscopy-and-Laryngoscopy-CPT-Codes.cfm ) for more on using modifier 59 in very rare nasal endoscopy/laryngoscopy instances.

Beware: Fail to carry this out, and your claim for the second scope will be denied.. Interestingly, the column 2 code in this situation is the code with higher RVUs, which is not the normal pairing. This means that incorrectly unbundling and billing 31231 and 31575 will cause the practice to be paid for the column 1 code (the lower RVU code 31575), and not be paid for the higher RVU code 31231. Without submitting supportive medical records, the payer is also not likely to reconsider the denial. Always make sure that documentation supports billing the endoscopy as a distinct procedure. Show through documentation that your otolaryngologist performed endoscopy and laryngoscopy for different reasons.

Tip 2: Present Single-Complaint Laryngoscopy, Endoscopy With Just One Code

When the physician performs more than one scope, make sure the scope you code and bill is the scope that is best supported by the final diagnosis. So, if the reason for the test and ultimate diagnosis is eustachian dysfunction (381.81, Dysfunction of eustachian tube), you should report a nasalpharyngoscopy (92511) -- the medically supported service.

On the other hand, if the complaint/final diagnosis is related to nasal obstruction (478.19, Other disease of nasal cavity and sinuses) and sinusitis (473.9, Unspecified sinusitis [chronic]), a nasal endoscopy, 31231 is medically supported. Finally, if the patient complains of dysphagia (787.2, Dysphagia), and has vocal cord nodules (478.5, Other diseases of vocal cords), a laryngoscopy, 31575 would be supported.

Example: The patient presents to the office complaining of difficulty in swallowing (787.2). To evaluate this complaint, the otolaryngologist decides to perform endoscopy and laryngoscopy. However, you shouldn't report the endoscopy (31231) on your claim. Why? The otolaryngologist employs both scopes for the same reason, so the Medicare bundling rule for 31231 and 31575 applies. You would code only 31575 because the diagnosis 787.2 does not support a nasal endoscopy (31231) from a medical necessity perspective, but it supports 31575.