Otolaryngology Coding Alert

Question: I submitted a claim for 31267 and 61782 using the same diagnosis. The insurance paid for 31267, but denied 61782 as 'inclusive.' I was told I should resubmit with a modifier. Is modifier 59 appropriate?South Carolina SubscriberAnswer: No. Do not apply modifier 59 (Distinct procedural service) because it is not a separate site or separate encounter. FYI, 61782 (Stereotactic computer-assisted [navigational] procedure; cranial, extradural [List separately in addition to code for primary procedure]) is an add-on code, which means it belongs with 31267 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus). Because 61782 is an add-on code, you also would not use modifier 51 (Multiple procedure).Use the policy on the American Academy of Otolaryngology -- Head and Neck Surgery web site (URL: www.entnet.org/Practice/policyIntraOperativeSurgery.cfm), and fight for payment. You don't need any modifiers when using 61782 unless the private payer has their own policy on [...]