Otolaryngology Coding Alert

Question: The ENT physician performed endoscopic control of a nasal hemorrhage and placed bilateral Doyle II internal nasal splints and dissolving fibrillar surgical packs in both nasal cavities. Should we report 31238-50? And how should we code the subsequent removal of the splint and packing?

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Answer: Since your physician documented the use of endoscopy for controlling the bleeding, then 31238-50 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage, Bilateral procedure) is likely your best option for the first procedure, so it looks like you coded that accurately.

As for the removal of packing and splinting, those services are typically part of the evaluation and management (E/M) service during that subsequent visit (99202-99215). There are some exceptions, however, depending on how the physician removed the packing and splinting.

If the ENT uses a scope to assist in removing the splinting and packing, then the documentation might warrant 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)). If the physician puts the patient under anesthesia and uses a nasal speculum to remove the splint and packing, then 92502 (Otolaryngologic examination under general anesthesia) is likely the best option.

The bottom line is that a code for the removal will be based on the documentation, what the physician did during the service, and whether anesthesia or a scope was involved.