Otolaryngology Coding Alert

Question: Yesterday a patient had 30520 and 30140-50. Later that day, the patient returned to the OR for 31238. Should I use modifier 78 on 31238?

Maryland Subscriber

Answer: Because the bleed control (31238, Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) occurs on the same day as the septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and bilateral turbinate resection (30140-50, Submucous resection inferior turbinate, partial or complete, any method; Bilateral procedure), append 31238 with modifier 59 (Distinct procedural service).

The modifier indicates the otolaryngologist performed 31238 at a different operative session. Since control of bleeding is incident-to any surgery, modifier 59 shows that he control took place at a different operative session.

If the epistaxis control was on a different day from the nasal surgeries, different modifiers would come into play. Choose the appropriate modifier based on the nasal hemorrhage control’s relation to the nasal surgery.

If the bleed was from the operative site, append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to 31238. When the hemorrhage is unrelated to the nasal surgery, i.e., from a dry nose in the winter season, use modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) on 31238.