Otolaryngology Coding Alert

Question: How do you code the revision of an ethmoidectomy or sphenoidotomy?

Texas Subscriber

Answer: There are no separate codes for revision of ethmoidectomy, sphenoidotomy or any other sinus endoscopy codes. As a result, for the ethmoidectomy revision, 31254 (nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) or 31255 (nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) should be used, depending on the approach used by the otolaryngologist. If a sphenoidotomy were performed, the correct code would be either 31287 (nasal/sinus endoscopy, surgical, with sphenoidotomy) or 31288 (nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus), again depending on the approach.

Sometimes, however, the revision may be more complex than the original procedure, as a result of scarring, adhesions or other changes to the anatomic structure of the sinus caused by the original procedure, says Cheryl Odquist, CPC, an independent otolaryngology coding and reimbursement specialist in San Diego.

If that is the case modifier -22 (unusual procedural services) could be added to the appropriate procedure. Coders should remember that such claims need to be accompanied by clear and accurate documentation explaining why the procedure was more complex. Odquist recommends including an indications paragraph in the operative report that states what the otolaryngologist found in the sinus that justifies the request for additional funds by attaching modifier -22. For example, the indications section could note excessive blood loss that made it difficult to visualize the anatomic structure being resected, she says.

Although many carriers will not pay more for such revisions in any case, if enough additional work was performed and documented to warrant such a claim, it should be coded and billed nonetheless.