Otolaryngology Coding Alert

Question: A new patient came to our office for removal of nasal packs (a different physician had placed the packs during a hospital encounter). Our physician also completed a nasal endoscopy to control bleeding. Is there a code for nasal pack removal? It’s not a foreign body, so I’m not sure how to consider it.

West Virginia Subscriber

Answer: Reporting the endoscopy with a code such as 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) would include the removal of previous packing. When using 31238, make sure that the doctor is actually using the endoscope to control the bleed. If he is using the endoscope to locate the bleed and then pulling the endoscope out and then controlling the bleed without the scope, you do not code for the endoscope, you only code 30901-30906, whichever is appropriate. A diagnostic endoscopy, 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]), is considered bundled with all of the control of epistaxis codes.

Another scenario: Your coding would change if the patient came for the packing removal and your physician didn’t perform another service. There is no code for removal of nasal packing and no matter who packed the nose, your physician or another physician, you would report the appropriate E/M code for new patient services (99201-99205).