Otolaryngology Coding Alert

Question: A patient had a functional endoscopic sinus surgery (FESS) six days ago. The patient returned today for a nasal endoscopy for debridement purposes. Can I bill out this procedure this soon into the post-op period?

Arkansas subscriber

Answer: To determine whether or not a procedure is billable at a particular point in the post-operative period, you must look at the code’s global period. In the case of FESS procedures, the global period is 0 days, except for 31239 (Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy) which has a global period of 10 days.

According to CMS, “The global surgical package, also called global surgery, includes all necessary services normally furnished by a surgeon before, during, and after a procedure.” While follow-up surgical intervention is extremely common when it comes to FESS procedures, Medicare does not consider a subsequent endoscopy as an included portion of the original surgery.

Assuming the original procedure did not include a dacryocystorhinostomy, you can confidently bill for code 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) without any modifiers appended.

Don’t forget: FESS surgery is often performed with the open procedures 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft), 30130 (Excision inferior turbinate, partial or complete, any method) or 30140 (Submucous resection inferior turbinate, partial or complete, any method), which has a 90-day global. From the payer’s perspective, the 90-day global period applies to the entire surgery, including the FESS procedures. When this is the case, and the debridement has nothing to do with the septum or turbinates, code for the post-operative debridements with modifier 79 (Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period) in order to show the payer that the debridements are not associated with the procedures that created the global period.

Two things to consider: On the subject of global periods, keep in mind that a follow-up procedure within a surgery’s global period cannot be billed, even if it is performed by a different provider within the same practice. Medicare guidelines state that physicians of the same practice “must bill and be paid as if they were a single physician.”

Additionally, while most FESS procedures do not have global periods, additional related visits on the day of the original (or subsequent) procedure will generally not be paid.