Otolaryngology Coding Alert

" Coding diagnostic nasal endoscopy can prove a challenge, considering a handful of codes cover this procedure:

31231 nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)

31233 nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)

31235 nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium)

31575 laryngoscopy, flexible fiberoptic; diagnostic

92511 nasopharyngoscopy with endoscope (separate procedure).
Note: Codes 31233 and 31235 describe more extensive endoscopies (involving sinusoscopy) than the endoscopies described in the other three codes.
 
An even greater challenge presents itself when the coder reviewing 31231, 31575 and 92511 finds that 1) all three codes describe diagnostic nasal endoscopies, 2) the procedures described in all three codes may be performed using the same type of scope, 3) the three codes are not grouped in the same section of the CPT manual and 4) each code has been assigned different RVU ratings.
 
To make coding easier, you need only consider what and where the otolaryngologist performed and the documented reason for the procedure.
 
The difference between nasal endoscopy and nasopharyngoscopy is simple" from a clinical standpoint. If you use a scope and look at the nasopharynx that's nasopharyngoscopy. If however you evaluate all of the nasal cavity including where the sinuses drain that's a nasal endoscopy " says Lee Eisenberg MD an otolaryngologist in private practice in Englewood N.J. and a member of CPT's Editorial Panel and Executive Committee.
 
Medicare carrier local medical review policies (LMRP) often tell otolaryngologists the same thing. For example the LMRP from Empire Medicare Services (Part B carrier in New Jersey and parts of New York) states that 31231 should be used "to report a diagnostic nasal endoscopy when studying the area extending from the nostrils to the posterior edge of the soft palate." The LMRP then instructs otolaryngologists not to use 31231 "to report a diagnostic endoscopy of the nasopharynx. CPT procedure code 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."
 
The diagnostic endoscopy is a more extensive procedure than a nasopharyngoscopy which is why it is assigned about 50 percent more RVUs notes Andrew Borden CPC CCS-P CMA reimbursement manager for the Department of Otolaryngology at the Medical College of Wisconsin in Milwaukee. "Nasopharyngoscopy does not involve looking at the anterior portion of the nose but rather using a flexible scope to look at the eustachian tubes adenoids and choanae (where the pharynx and the nasal passages meet at the end of the hard palate) all of which are located around the nasopharynx " he says. In comparison he notes a diagnostic nasal endoscopy often [...]