Otolaryngology Coding Alert

Question: We are receiving denials for code 31298 due to an incorrect modifier. Do I need modifier 50 to report a bilateral procedure?

California Subscriber

Answer: When determining whether a code is inherently bilateral or requires the reporting of modifier 50 (Bilateral Procedure), you must check the code’s bilateral surgery indicator. This can be achieved by using a physician coder such as Codify, or by accessing the Medicare Physician Fee Schedule Data Base (MPFSDB) at https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx.

You will find that 31298 (Nasal/sinus endoscopy, surgical; with dilation of frontal and sphenoid sinus ostia (eg, balloon dilation)) has a bilateral surgery indicator of “1,” which means that you may either submit the claim using modifier 50 or on two lines using the LT (Left Side) and RT (Right Side) modifiers, depending on how the payer wishes bilateral procedures reported. For unilateral procedures, you may bill with modifier LT or RT.