Otolaryngology Coding Alert

Question: When an otolaryngologist provides epistaxis control using an endoscope, I report 30901 and 31231. Insurers keep bundling the nosebleed control into the endoscopy code. Should I appeal these EOBs?


Illinois Subscriber

Answer: The problem is with your coding, not the insurer's policy. CPT includes a specific code for endoscopic epistaxis control: 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage). In this procedure, the otolaryngologist "uses an endoscope for a diagnostic evaluation of the bleeding nose" and then places electrocautery instruments or lasers parallel to the endoscope to stop internal nose bleeding, according to Ingenix's Coding Companion for ENT/Allergy/
Pulmonology.

In contrast, code 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing], any method) accounts for only cautery and/or packing to control the nosebleed (such as 784.7, Epistaxis). When the otolaryngologist uses an endoscope for a diagnostic evaluation of the nose and that is the only procedure he performs in that anatomic area, you should report 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]).

Tip: You should pay close attention to how the otolaryngologist's operative note (OR) describes endoscopic use. If the otolaryngologist uses the endoscope to find the bleeding's location and then takes the scope out prior to performing cautery and/or packing, you should not use 31238. You should instead assign the appropriate nasal hemorrhage control code (30901-30906).

Key: To report 31238, the otolaryngologist must use the endoscope to assist in epistaxis control.