Otolaryngology Coding Alert

Question: In our office, we usually do direct laryngoscopy (31575) and a sinus scope (31231) with video equipment so the physician can actually look in at the sinuses and take a video or still picture, magnify it and make copies. When we purchased the equipment, we were advised to use code 70371 (complex dynamic pharyngeal and speech evaluation by cine or video recording) to bill over and above the actual procedure, which doesnt really encompass sinusesits more for vocal chord problems. Lately theres been an increase in denials, and now I am about to try using a 31299 (unlisted procedure, accessory sinuses) to gain reimbursement. Which code should we use?

Tina Gerard
New York City

Answer: The short answer comes from Janet McDiarmid, CMM, CPC, MPC, past-president of the American Academy of Professional Coders, who says, I do not know of any carrier who will pay for the 70371 with codes 31575 and 31231. Code 70371 is not an appropriate code for those procedures.

Susan Callaway Stradley, CPC, CCS-P, a consultant in the medical division of Elliott, Davis & Co., a healthcare accounting firm in Augusta, GA, adds: You have to step back with any new technology and ask yourself a couple of questions:

(1) Have we increased or decreased risk to the patient? If you have decreased risk to the patient, it is unlikely a carrier will pay you for that. In fact, youll be lucky to keep billing the same original fee code.

(2) Is there a significant medical reason the videos or pictures are used, or are they mainly used to aid physician documentation? If it is the latter, it will be seen as a benefit to the physician and wont be paid.

Unlike 70371 (complex dynamic pharyngeal and speech evaluation by cine and video recording), which, when used for vocal chords is a legitimate diagnostic and therapeutic tool, the use of the video for sinuses is viewedrightly or wrongly by many carriersprimarily as a physician convenience.

If the procedure took significantly longer to complete because of efforts to use the equipment, Stradley says, you might be able to add a -22 modifier (unusual procedural services) to a 31575 or 31231. But she cautions that supporting documentation would have to be included that showed the patients circumstances were so different from a typical procedure that it justified using the equipment.
New equipment often allows physicians to offer a better quality of life to their patients while simultaneously lowering their risk. However, this rarely translates into higher reimbursement for the physician.

A final piece of advice regarding taking a salesmans word about coding: It is easier to sell expensive medical technology if you can persuade the prospective buyer that using the new equipment has a code and is reimbursable. Before you buy, consult a coding expert or the American Medical Association (which established CPT).