Otolaryngology Coding Alert

Question: What is the correct way to code for nasal endoscopy and laryngoscopy procedures performed in the office on the same day?

Idaho Subscriber

Answer: You may report 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) appended by modifier 59 (Distinct procedural service), and 31575 (Laryngoscopy, flexible fiberoptic; diagnostic), and get separate reimbursement for each code -- but in very rare instances. (See the article "31231, 92511 and 31575: Weigh Your Code Selection Options Based On Complaints," which appeared on October 2011 Otolaryngology Coding Alert, discussing the same topic.)

The National Correct Coding Initiatives (CCI) specifically indicates, "CMS will not modify the modifier indicators for these edits continuing to allow use of NCCI-associated modifiers. A provider should not report both codes of a code pair edit if the nasal endoscopy can be performed with the same flexible endoscope utilized for the laryngoscopy. However, we understand that there are very occasional circumstances where it is medically reasonable and necessary for a provider to perform the nasal endoscopy with a separate rigid endoscope. In the latter scenario, a provider may report both codes of a code pair edit utilizing an NCCI-associated modifier."

Background: In 2008, CCI and Centers for Medicare and Medicaid Services (CMS) put an end to the confusion by rendering a final decision to maintain the ability to override the edits with modifier 59 for 31231.

However, when you do code 31231 and 31575 separately, make sure you provide satisfactory documentation that explains the need for using two different endoscopes on the same date of service.

Big risk: If the payer finds out that every time you perform a nasal endoscopy and a laryngoscopy you use modifier 59, and have a template paragraph for medical necessity, they will be suspicious of the true support for coding both these codes and the modifier, Each patient should have documented medical documented unique to their conditions.

Should you need support for your coding and use of these codes, you can find an article on the American Academy of Otolaryngology/Head and Neck Surgeons website at www.entnet.org/Practice/Reporting-Nasal-Endoscopy-and-Laryngoscopy-CPT-Codes.cfm.