Otolaryngology Coding Alert

Question: An otolaryngologist performed nasal endoscopy and had to cauterize nasal bleeding. I billed it as 30901-59 and 31231, but got denied for the latter. Should I have used 31238 instead?

Idaho Subscriber

Answer: You may be correct. The more specific code 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) literally means to control nasal bleeding endoscopically.

Other angle: If the physician used the endoscope to look at the nasal passage and control the bleeding and not look at the sinuses, you can consider using 31238. Nasal endoscopy is not just for viewing sinuses but for nasal cavity, as well. To use 31238, the nasal endoscopy should assist the control of the epistaxis procedure (cautery or packing). If the endoscopy is just to look at the situation and assess it and then the physician goes back in after the scope is pulled out to control the bleed, you should not report 31238. You should code only the appropriate control of epistaxis.

Blunder: To report both 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) and 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) is considered "unbundling," so stick with 31238. You should use 30901 specifically if the physician took a silver nitrate to stop an anterior nosebleed or packed the nose with a cotton pledget.