Otolaryngology Coding Alert

Question: If I see a postoperative endoscopic sinus surgery patient and do a debridement and code the visit as 31237 (nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]), do I collect a co-pay? Can I charge for an E/M visit as well?

Florida Subscriber

Answer: The co-pay depends on the contract signed with the carrier, but it probably should be collected, says Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist in Lakewood, N.J. If it is subsequently disallowed on claim processing, it can be refunded to the patient or applied to a subsequent visit.

If the debridement was scheduled based on the prior evaluation and management (E/M) service, you would not charge for any E/M performed on the day of the debridement, Cobuzzi says. If, however, on performing the E/M, you determine that the patient needs debridement, you can charge for the E/M and the debridement. The appropriate E/M code should be appended with a -25 modifier (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to indicate the evaluation was separate from the debridement.