Otolaryngology Coding Alert

Be sure to differentiate between polyps and lesions before coding.

When your otolaryngologist diagnoses a polyp of the nasal cavity, you submit 471.0 (Polyp of nasal cavity) from ICD-9. These polyps are the most common benign growths in the nasal cavity. They are a reflection of inflammation, not tumors that suggest an increased risk of cancer. 

Coming soon: When ICD-10 becomes effective on Oct. 1, the correct diagnosis code for polyps of the nasal cavity will be J33.0. The shift will be easy from a coding perspective because the descriptor will remain the same. 

Documentation: This diagnosis should also be referred to as a “choanal” or “nasopharyngeal” polyp.

Coder tips: A related diagnosis from ICD-10 represents removal of a patient’s intranasal lesion (J33.0). Watch the details of your provider’s documentation to differentiate between a lesion and a polyp. 

Nasal polyps may block drainage from the sinuses, which is why they need to be removed. Your otolaryngologist may perform a biopsy of the polyp to ensure that it is not cancer. 

Procedures that patients might have in relation to nasal polyps include the following: 

• Endoscopic removal of a polyp or a biopsy of a polyp (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) 

• Endoscopic removal of a concha bullosa (a large air cell located at the middle turbinate) (31240, Nasal/sinus endoscopy, surgical; with concha bullosa resection) 

• Open (non endoscopic) removal of polyps, which is coded as either 30110 (Excision, nasal polyp[s], simple) or 30115 (Excision, nasal polyp[s], extensive). 

Surgeons often perform 30110 in an office setting and 30511 in a facility. Open polypectomy procedures 30110 and 30115 are seldom performed, however, since endoscopic surgery has become the standard of care.  However there may be some situations when open polypectomies are performed. If the surgeon removes a lesion from the nose via open approach instead of an endoscopic polyp removal, you should report 30117 (Excision or destruction [e.g., laser], intranasal lesion; internal approach) or 30118 (Excision or destruction [e.g., laser], intranasal lesion; external approach [lateral rhinotomy]) when the approach is external, coming from the outside of the nose.