Otolaryngology Coding Alert

Question: The otolaryngologist's notes state that endoscopic sinus surgery with right middle meatal and inferior meatal antrostomy, as well as bilateral nasal polypectomy, was performed. Should we bill for the polypectomy on the left side?

Washington Subscriber

Answer: The operative report must be read to determine whether tissue was removed from the maxillary sinus. If no tissue was taken, 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy) should be reported. If tissue was removed, 31267 ( with removal of tissue from maxillary sinus) may be used.

According to the information presented in the subscriber's question, the antrostomy was performed on the right side, whereas the polypectomy was bilateral. The term "nasal polypectomy" may be taken to mean polyps in the nasal passage. This procedure, which is reported using 30115 (Excision, nasal polyp[s], extensive), is incidental to nasal sinus surgery because it is performed to access the sinus (much like middle turbinate procedures). Therefore, it may not be reported separately on the right side, where the maxillary antrostomy was performed. Code 30115 may be used to report the left-side nasal polypectomy.

The polypectomy most likely was performed endoscopically because the maxillary antrostomy is performed endoscopically. If this is the case, 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) would be more appropriate than 30115 and may be reported in addition to 31256 or 31267. Modifier -59 (Distinct procedural service) should be appended to the appropriate polypectomy code.

To further illustrate the importance of clear and accurate documentation, 30115 has a 90-day global period, which means that if this procedure is reported, any follow-up on the nose or sinuses is included in the global surgical package and should not be reported separately. The endoscopic sinus surgery codes 31256 or 31267 all have zero-day global periods.

If the maxillary antrostomy was bilateral, the polypectomy should not be billed. Similarly, when polyps are removed from the maxillary sinus and not from the nasal cavity, the polypectomy is included in 31267 and may not be reported separately. (31256 does not apply because the procedure involved the removal of tissue [i.e., the polyps] from the maxillary sinuses.)

Note: A nasal polypectomy occasionally may be difficult and considerably more extensive than usual. In such cases, appending modifier -22 (Unusual procedural services) to the FESS code may be appropriate.

You Be the Coder and Reader Questions were answered by Randa Blackwell, coding and reimbursement manager for the department of otolaryngology at the University of Maryland in Baltimore; Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.; Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.; Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPT's editorial panel and executive committee; and Michelle Logsdon, CPC, CCS-P, a coding and reimbursement specialist in Toms River, N.J.