Otolaryngology Coding Alert

Question: Can you bill 31295 for maxillary sinus balloon dilation with 31000 for lavage? I’ve seen that a modifier can be put on code 31000 to possibly report both codes, but another coder told me you couldn’t do that. Is 31000 included in the 31295 or can I bill it separately?

South Dakota Subscriber

Answer: You should be able to submit 31000 and (Lavage by cannulation; maxillary sinus [antrum puncture or natural ostium]) 31295 (Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium [e.g., balloon dilation], transnasal or via canine fossa) on the same claim if and only if the lavage was performed on a different side from the balloon dilation. Append either modifier 59 (Distinct procedural service) or for Medicare Part B, XS (Separate structure) to 31000 to show that your physician performed two separate services on the other side of the sinuses, and make sure that the documentation reflects that the two procedures were performed on separate sides for  the encounter.