Otolaryngology Coding Alert

Question: The physician completed 31231 in the office for sinusitis, but he also needs to insert a rigid scope (31575) because the patient also has reflux and hoarseness. Can we bill for both since he is removing one and doing another one for different diagnosis?

Delaware Subscriber

Answer: The correct answer depends on the insurance company. Sometimes if you add a 59 modifier (Distinct procedural service) to 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]), they will pay it in addition to 31575 (Laryngoscopy, flexible fiberoptic; diagnostic). 

Caution: Remember that just because you can add modifier 59 to two procedures and get paid for both doesn’t mean you’re supposed to do it. If you don’t have supporting documentation that justifies reporting both codes, you might get paid but could get “caught” for fraud in future audits. High utilization of the 59 modifier is a major red flag for audits. Although the American Academy of Otolaryngology/Head and Neck Surgery does indicate on its website that both these codes can be reported by including modifier 59, they stress that there must be documentation why the same scope that was used to inspect the nose and sinuses could not be used to inspect the larynx and/or hypopharynx.  

Keep in mind that should practices start using modifier 59 and billing both 31231 and 31575 (or 92511 when appropriate), we should not be surprised to soon find the NCCI modifier change to a 0, which would mean that the modifier can never be used.