Otolaryngology Coding Alert

Question: Our ENT performed a diagnostic endsocopy in the morning and epistaxis control in the afternoon for a Medicare patient. We appended modifier 59 to 30903 and also reported 31231. When using modifier 59, should we expect payment at 100 percent or does the multiple procedure rule come into play (and therefore discount the 30903)?

Nevada Subscriber

Answer: The latter should be your option. CPT® 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) would be reduced as a multiple procedure. Although you may not think it's fair to receive a reduced payment for multiple procedures since these were performed in different patient encounters, this is how CMS payment rules work. It is similar to how CMS applies multiple procedure discounts when multiple procedures are performed on entirely different anatomic areas, which means the doctor does not get the advantage of working through a single incision, (for example, a tonsillectomy and BMT performed on the same day will result in a multiple procedure discount for the BMT)

Caution: If you use modifier 51 (Multiple procedures), you do not use modifier 59 (Distinct procedural service). You use only modifier 59 or modifier 51, whichever is applicable. Since 30903 is not modifier 51 exempt or an add on code, the procedure would be reduced as a multiple procedure.