Otolaryngology Coding Alert

Question: My otolaryngologist performed an endoscopic partial septectomy for malignancy with nasal/sinus endoscopy with debridement. How should I bill the procedures?

Indiana Subscriber

Answer: Even though your otolaryngologist performed a septectomy and debridement, you should only code the procedures as 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]). This code includes both the septectomy and the endoscopic nasal cavity debridement.
 
Beware: If the surgeon also performed other functional endoscopic sinus surgery(ies) (FESS) (31237-31294) at the same session, you shouldn't assign 31237. CPT designates 31237 as a separate procedure. Therefore, you should report biopsy, polypectomy or debridement only when the otolaryngologist performs no other sinus surgery.
 
You may, however, bill the extra work with modifier -22 (Unusual procedural services). If your otolaryngologist clearly documented the added debridement work and this supports higher payment, append modifier -22 to the other FESS code, such as 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]).