Revenue Cycle Insider

Question: A patient with a deviated septum underwent a septoplasty. We followed up the following day, but the following week, the patient underwent a bilateral endoscopic sinus debridement. We billed the payer 30520 for the septoplasty and 31237 with modifiers 50 and 58 for the debridement. The claim for 31237 received this message: “Pre-/postoperative care payment is included in the allowance for the surgery/procedure,” and I am not sure why. Is this because the debridement occurred during the global period for the septoplasty? Should we have used a different modifier on the 31237, or should we expect no payments for these claims?

AAPC Forum Participant

Answer: While it is true that 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) has a global period of 90 days, that is not the reason for the 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)) denial. As the descriptor for 31237 states, this is a separate procedure and, as such, is not bundled into the global period for the 30520.

However, you are correct in saying that the denial is due to an incorrect modifier on 31237. In your case, using modifier 50 (Bilateral procedure) on the debridement, if it was performed bilaterally, is correct; but modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) is not, as the debridement is not staged or related to the septoplasty.

Instead of modifier 58, then, you should append modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period). This is consistent with the advice provided in CPT^Ò Assistant Volume 31, Issue 7 (July 2021), which tells you that “Sinus debridements within the global period of another intranasal procedure that generally does not require debridement, such as septoplasty, may be reported by appending modifier 79.”

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC