Otolaryngology Coding Alert

Question: Our surgeon performed a diagnostic endoscopy (31231) and a submucous turbinate resection (30140), but the insurer denied 31231. What can we do to collect for both?


California Subscriber


Answer: Because CPT designates 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) as a -separate procedure,- you will not be able to collect for this service when you perform it with another procedure in the same anatomic area. The insurer considers the endoscopy -incidental- to the other procedure and will deny payment for it.

If you can show the payer that you performed the procedures on separate sites (one on the sinus area, the other on the inferior turbinate), you may be able to appeal. Remind the insurer that CPT changed the definition of 30140 (Submucous resection inferior turbinate, partial or complete, any method) in 2006 to include only the inferior turbinates and not the
middle turbinates.

If the insurer denies your procedure because it erroneously believes that you performed the resection on   the middle turbinates, you can show them the documentation proving that the resection was actually on the inferior turbinates.

The insurer may instruct you to begin appending modifier 59 (Distinct procedural service) to 31231 in the future to show that the sinuses are located at a different site from the inferior turbinates. Ask your payer how you should file these claims and have the op report ready so you can prove the separate sites that the surgeon addressed.