Otolaryngology Coding Alert

Question: I submitted notes to my insurer multiple times, and they are continuing to deny my claims for nasal endoscopy (31231), stating that the elements of the interior nasal cavity were not inspected, even though the note clearly states that the physician inspected “all elements.” Can you advise?

Maine Subscriber

Answer: Unfortunately, documenting that “all elements were inspected” may not meet the requirements laid out by your insurer for 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure). If you read the introductory text just before 31231 in your CPT^® code book, it specifically states what should be examined during a diagnostic endoscopy, and you must specifically name each area listed there in your documentation.

For 31231, you’ll have to specifically indicate that the surgeon used the endoscope to inspect the interior of the nasal cavity, the middle and superior meatus, the turbinates, and the speno-ethmoid recess, according to CPT^® guidelines. If you don’t have these elements listed in the procedure report, the insurer has no way of knowing that you addressed them.

If the surgeon doesn’t mention all of these anatomic areas, then you may need to append modifier 52 (Reduced services) to 31231; or find another code that more accurately describes what was documented in the medical record.