Otolaryngology Coding Alert

Question: Our otolaryngologist recently performed a sinus endoscopy, during which she removed tissue from the patient’s maxillary sinus cavity. Before the endoscopy, the otolaryngologist lavaged the maxillary sinus using cannulation. Can I report separate codes for the endoscopy and the lavage?

Maine Subscriber

Answer: Unless there were extenuating circumstances, you cannot report a lavage and an endoscopy of the sinuses for the same patient during the same encounter. On the claim, you would report 31267 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus) for the procedure.

Why not 31000? In the encounter you describe, the lavage would be considered part of the normal presurgical services the otolaryngologist might provide before a sinus endoscopy. Therefore, you would not be able to report 31000 (Lavage by cannulation; maxillary sinus [antrum puncture or natural ostium]) along with 31267.

In some situations, you might be able to report 31267 and 31000 for the same patient for the same encounter — but not for the encounter you describe.

For example, let’s say the otolaryngologist performs a maxillary sinus endoscopy on the patient’s right side, and a maxillary sinus lavage on the patient’s left side. For this hypothetical encounter, you might be able to report 31267 and 31000 with modifier 59 (Distinct procedural service)/X appended.

Caveat: A claim with 31267 and 31000 would be rare; before filing a claim with both codes, make sure you have your documentation in order so that it explains why you are coding the endoscopy and lavage separately.