Otolaryngology Coding Alert

Question: A patient recently had sinus surgery and is following up with our physician post-op. Is it appropriate to bill for the nasal endoscopy to evaluate healing and to remove splints? The physician is not performing debridement or taking any samples for biopsy.

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Answer: Remember that the endoscopic sinus surgery codes have a zero-day global period. That means a nasal endoscopy (31231, Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure] or 31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)) done post-operatively is billable. 

If your surgeon performed any other procedures in conjunction with the sinus surgery such as septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and/or turbinectomies (30130, Excision inferior turbinate, partial or complete, any method, or 30140, Submucous resection inferior turbinate, partial or complete, any method), then you add a 90-day global to the surgery. If your surgeon does a nasal endoscopy post-operatively with that scenario, you’ll need to verify the reason for the scope (to check the healing of sinuses, to remove splints from the septoplasty, etc.). If the sinus endoscopy is applicable to only the sinuses and not the septum and/or turbinates, the scope is still billable in this scenario if you append modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period). It could be considered a difficult scenario to support, so you need to have good documentation to support the separate nature of the scope, indicating that the procedure is only for the sinuses.