Otolaryngology Coding Alert

Question: My otolaryngologist performed sinus endoscopy and suctioned only the purulent mucous from the sinus. I'm inclined to report sinusectomy. What is the appropriate code?

Answer: In this case, you should bill only 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) because nothing was taken out other than excess mucous. The nasal endoscopy was diagnostic and done for the purpose of seeing what was going on. You should also note that the physician didn't send the material -- which wasn't abnormal -- to pathology. If the physician removed necrotic material or tissue -- not just suctioning mucus/pus -- then you should report 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]).

Note: Don't even think about billing 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) or 31255 (...with ethmoidectomy, total [anterior and posterior]), 31267 (...with removal of tissue from maxillary sinus), or 31288 (...with removal of tissue from the sphenoid sinus). These codes require that a sinusostomy or ethmoidectomy be performed.