Otolaryngology Coding Alert

Question: An office nurse cleans a post-sinus surgery patient's nose with Hydro Pulse Nasal Irrigation. Should I report 31237? If so, should I append a modifier to the procedure code?

California Subscriber

Answer: No, you should submit 31000-52 (Lavage by cannulation; maxillary sinus [antrum puncture or natural ostium]; reduced services) as long as the otolaryngologist doesn't perform nasal endoscopy or debridement. When your otolaryngologist performs these typical postoperative functional endoscopic sinus surgery (FESS) procedures, you should assign 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) or 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) depending on his documentation.

When you give the patient the Hydro Pulse Nasal Irrigation kit ($90, approximate patient cost) to take home, you should report E1399 (Durable medical equipment, miscellaneous). Insurers, however, may not pay the miscellaneous supply code.

Therefore, you should collect cash up-front. Offer to submit the claim for the patient and issue a refund if the insurer covers the kit.

Alternatively, you can arrange for the hospital to distribute the kit while the postoperative patient is on the floor or in recovery.