Otolaryngology Coding Alert

Question: Our surgeon performed a septoplasty (30520) and then, during the postoperative period, used a scope to see how well it had healed. We reported 31231 for the endoscopy and the claim was denied as being part of the global surgical package. Should we have used a modifier? If so, which one?

Codify Subscriber

Answer: There is no modifier that can be applied. Since the surgeon uses an endoscope to see how well the septoplasty is healing, it’s considered part of the global surgical package and is not separately billable. This means that the modifiers that would break the global (modifier 58 [Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period] or 79 [Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period] do not apply. Therefore, you cannot report 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)) when it is being performed to track the progress of the septum healing.

Instead, your reimbursement for 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) covered all service related to the septum for 90 global days.

Had a procedure unrelated to the septum been performed — for example, a debridement of the sinuses — then the 31237 could be submitted with either a staged modifier (58) or an unrelated modifier (79) and it should be paid since the sinus debridement was unrelated to the global that was created by the septoplasty.