Otolaryngology Coding Alert

Question: Is 31231 considered a component of 31237 when 31231 is performed on the left side and 31237 is performed on the right side?

Indiana Subscriber

Answer: You may never bill out 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) with 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) due to Correct Coding Initiative (CCI) restrictions. According to CCI, these two procedures are mutually exclusive. Code 31231, as a separate procedure, is also considered inclusive to any other procedures that the provider performs in the same anatomic area.

If, for example, the provider initially sets out to perform a bilateral diagnostic nasal endoscopy and finds nothing of concern, you may bill out as 31231.

However, if the provider initially performs a bilateral diagnostic nasal endoscopy finds a nasal polyp in the right nostril, for example, your coding options will change. Assuming the provider opts to surgically remove the polyp (polypectomy), you will exclusively bill out as 31237-RT.