Otolaryngology Coding Alert

Question: When billing for procedure code 31231 (nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) during the post-op period, should modifier -58 be used?

Anonymous coder, MA

Answer: If we assume that the post-op period refers to the primary procedures global period, there are two modifiers that may be used, depending on the circumstances. If the nasal endoscopy was preplanned, then the 31231 should be billed with modifier -58 (staged or related procedure or service by the same physician during the postoperative period). But if the patient requires the endoscopy for an unrelated, separate medical problem, the correct modifier would be -79 (unrelated procedure or service by the same physician during the postoperative period).

If the patient had abnormal, extensive complications that required a return to the operating room, modifier -78 (return to the operating room for a related procedure during the postoperative period) would need to be attached. More typical complications handled in the physicians office, like any related E/M service, would be covered under the original procedures global period.