Otolaryngology Coding Alert

Question: We performed a septoplasty for a patient and then used a nasal endoscopy to examine his sinuses during the septoplasty's global period. Is the endoscopy separately reportable? If so, which modifier should I report on the endoscopy?

Idaho Subscriber

Answer: The answer depends on medical necessity. If the ENT performed the scope to merely check the healing status of the septoplasty include the scope as part of 30520's (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) 90-day global surgical package.

If the ENT performed the endoscopy, however, for a different complaint, such as sinus headaches (346.10, Migraine without aura ...) and sinusitis (473.0, Chronic sinusitis; maxillary; and 473.2, Chronic sinusitis; ethmoidal), that is a different story. In this case, you may append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 31231 (Nasal endoscopy, diagnostic,  unilateral or bilateral [separate procedure]) because the endoscopy would be unrelated to the global period's procedure: the septoplasty.

You also may be able to report an E/M for the sinus headache complaint, depending on the documentation. Show insurers the E/M is unrelated to the global period employing these four tips:

1. Put modifier 24 (Unrelated evaluation and management service by the same physician during the global period) on the office visit code (99212-99215, Office or other outpatient visit ...) to indicate the E/M is unrelated to the existing global period.

2. Link the documented non-septum diagnoses, such as headache (346.10) and sinusitis (473.0, 473.2) to 31231-79 to show the endoscopy is related to the headache.

3. Make sure the documentation that you are basing your E/M level on totally carves out any septum care of findings and relates only to the patient's headaches.

4. If the otolaryngologist is performing a diagnostic endoscopy andhas documented an E/M service that is significant and separately identifiable from the scope, also use modifier 25 to indicate that the E/M is beyond the very small E/M associated with the minor procedure. Thus, the E/M will have both the 24 and 25 modifiers when performing the scope for an unrelated reason in the septoplasty global and you would therefore code 9921x-24-25 and 31231-79 with the unrelated diagnosis.

Be prepared to fight for payment. Many practices find that they have to appeal even if they have a different diagnosis and modifier 24 on the E/M.

-- Answers to You Be the Coder and Reader Questions reviewed by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of New Jersey-based CRN Healthcare Solutions.