Otolaryngology Coding Alert

Question: Could an otolaryngologist perform 31254 and 31255 at the same session? Is it possible to do one on one side and the other on the other side?

New Jersey Subscriber

Answer: Yes. An otolaryngologist could perform partial ethmoidectomy (31254, Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) on one side and total ethmoidectomy (31255, ... with ethmoidectomy, total [anterior and posterior]) on the other side.

Tip: Use modifier 59 (Distinct procedural service) on the partial ethmoidectomy code to indicate the other site. In other words, you would code such a case as 31255 and 31254-59.

Correct coding doesn't require you to use modifier 59. Theoretically, you should be able to use body modifier indicators (LT, Left side; and RT, Right side) and bill 31255-RT and 31254-LT.

Problem: Payers often do not properly process modifiers RT and LT. In other words, insurers- software systems will consider 31254 a component of 31255 (which according to CPT it is when performed on the same side). Modifier 59 usually facilities overriding this assumed edit more than body modifiers do.

Exception: You may, however, find an insurer that will accept the body side modifiers. If you do, use RT and LT instead of modifier 59 because modifier 59 is the modifier of last resort.