Otolaryngology Coding Alert

Question: Can 31070 (sinusotomy frontal, external, simple [trephine operation]) and 31276 (nasal/sinus endoscopy, surgical frontal sinus exploration, with or without removal of tissue from frontal sinus) be used together? My doctor attempts entry into the frontal sinus only to find it obstructed, forcing him to obtain entry externally. He actually works from both directions to complete the procedure. According to the CCI edit, 31070 is bundled in with 31276. Can we code 31070 with the -59 modifier? Please advise what is proper in this case.

Joyce Rucker, CPC
Vanderbilt Abstraction, Nashville, TN

Answer: As the reader indicates, these procedures normally are bundled according to the National Correct Coding Initiative. In this case, the otolaryngologist began with an endoscopic procedure (31276) and had to switch to an open procedure (31070). But because the otolaryngologist has attempted two different approaches from both directions, it might be possible to bill for the 31276 with a -22 modifier (unusual procedural services). An op note should be attached to the claim form, as well as a note to explain that the procedure is being billed this way due to special circumstances, in this case, the different approaches from both directions.

Modifier -59 (distinct procedural service) would not be appropriate in this situation. Although two separate approaches are identified, there is only one site being worked on, so -59 would not apply. It should be used only when two separate procedures are performed on two separate sites, or at different times during the same day.

Since only one code can be billed, Barbara Cobuzzi, MBA, CPC, recommends billing the endoscopic procedure, 31276, with a -22 modifier. Not only does it have a greater number of RVUs and therefore reimburse more, but the procedure has 0 global days, whereas 31070, the open procedure, has a 90-day global period, meaning any further services by the otolaryngologist during that time will not be reimbursed. Cobuzzi adds that the fee on the HCFA 1500 claim should be raised to reflect the complexity of having performed both scope and open procedures.