Otolaryngology Coding Alert

Question: Can I report 31238 and 31231 together and be paid for both?

California Subscriber

Answer: No, the Correct Coding Initiative (CCI) bundles these codes. Code 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) is a separate procedure, which means that it is inclusive with any other procedure done in the sinuses. Additionally, a diagnostic scope is considered inclusive to control of epistaxis, any method. That includes any functional scope procedures (such as 31238, Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage).

The only reason a payer would pay for both these codes is if you indicate that these procedures took place at separate session. For instance, suppose the ENT does the diagnostic scope in the morning, and then he sees the patient for the epistaxis in the ER in the evening and uses the scope to control the bleed. In that case, you can bill both codes because the physician performed them at different session. You would have to apply modifier 59 (Distinct procedural service). You would bill 31238, 31231-59 since 31231 is the column 2 code.

Note: You cannot apply modifiers RT, LT (Right side, Left side) to break the bundle, because 31231 is "unilateral or bilateral," according to the descriptor.