Otolaryngology Coding Alert

Question: The surgeon performs an extensive bilateral removal of nasal polyps in the office. How do I decide between 30115 and 31237?

Kansas Subscriber

Answer: There’re a few points to unpack here. First, one of the underlying differences between code 30115 (Excision, nasal polyp(s), extensive) and 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)) is the surgeon’s use of an endoscope. If the surgeon performs the polypectomy without the use of an endoscope, you should not consider 31237.

However, you should keep in mind that a surgeon will not perform an “extensive” polypectomy during an in-office endoscopic surgery. This remains true with for a non-endoscopic polypectomy, as well. That means that you need to reconsider reporting code 30115, since the procedure was performed in an office setting. Code 30115 is traditionally reserved for polypectomy procedures in an outpatient facility setting such as outpatient hospital or ambulatory surgery center (ASC). Therefore, for a non-endoscopic polyp excision procedure performed in office, you should only consider reporting 30110 (Excision, nasal polyp(s), simple). If you feel that the surgeon went above and beyond the work included in code 30110, and have the documentation to back up that assertion, you may consider reporting 30110 with modifier 22 (Increased Procedural Services).

Since you indicate that the polyps are removed bilaterally, you will report modifier 50 with either 31237 if performed with an endoscope, or 30110 if performed intranasally without an endoscope using biting forceps or a scalpel. However, keep in mind that it is rare for polyps to be removed without an endoscope in 2019.