Otolaryngology Coding Alert

AAO cuts through AMA-caused confusion

If recent AMA advice has you headed to an unlisted-procedure code for transnasal endoscopy, answers straight from the AAO-HNS will have you sighing in relief.

Otolaryngology Coding Alert received the following article from Linda T. Ayers, MHCM, senior director of health policy at the American Academy of Otolaryngology- Head and Neck Surgery (AAO-HNS) in Alexandria, Va.

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has found that the AMA's May 2007 CPT Assistant (page 10) created considerable confusion among our membership regarding proper coding for transnasal diagnostic esophagoscopy. Although the question posed to the CPT Assistant did ask about coding for transnasal endoscopy when a full esophageal study is not performed, the majority of transnasal endoscopies do contain a full esophageal study. Therefore, the AAO-HNS would like to provide guidance on coding for different situations with transnasal endoscopy.

Use 43200 for TNE With Full Esophageal Study

Scenario 1: Transnasal esophagoscopy (TNE) is performed with examination of the entire esophagus to the gastroesophageal junction. How should this service be reported?

Answer 1: TNE is a procedure in which a thin, flexible endoscope is passed through the nares into the esophagus, without sedation. The typical examination visualizes the entire length of the esophagus to the gastroesophageal junction. This service is reported with 43200 (Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) using no modifier, consistent with moderate (conscious) sedation guidelines in CPT 2007 Appendix G: -When clinical conditions of the patient require such anesthesia services, or in the circumstances when the patient does not require sedation, the operating physician is not required to report the procedure as a reduced service using modifier 52.-

Report Partial Study as Reduced Service

Scenario 2: TNE is performed but not to the gastroesophageal junction. How should this service be reported?

Answer 2: When the procedure involves only a portion of the esophagus and does not extend to the gastroesophageal junction, one should use 43200 with the reduced services modifier 52 (43200-52).

Use 31575 When Esophagus Is Not Entered

Scenario 3: Transnasal endoscopy is performed only to evaluate the hypopharynx but does not enter the esophagus (i.e., the endoscope is not inserted past the cricopharyngeus muscle). How should this service be reported?

Answer 3: In this case, 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) should be used.

If an esophageal biopsy is performed using this technique, the correct reporting is 43202 (Esophagoscopy, rigid or flexible; with biopsy, single or multiple).

If there are any further questions regarding coding for transnasal endoscopy, please contact the AAO-HNS Practice Services department at (877) 722-6467.