Otolaryngology Coding Alert

Question: My ENT performed an endoscopic exam to view the interior of maxillary or sphenoid sinuses. He did this through existing surgically created patent sinusotomies, and this occurred after the postoperative period. Should I report both 31233 and 31235 for this procedure?

Delaware Subscriber

Answer: No. You should submit only 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]). Also, if your ENT performs this procedure on both sides, you still cannot report this code with modifier 50 (Bilateral procedure). The code descriptor includes "unilateral or bilateral."

Rationale: CPT codes 31233 (Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy [via  inferior meatus or canine fossa puncture]) and 31235 (Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy [via puncture of sphenoidal face or cannulation of ostium]) both involve a puncture or trocar cannulation prior to placing the scope into the sinus. Therefore, you shouldn't use either of these codes. Want to know more? You can find more informa-tion on the Academy of Otolaryngology - Head and Neck Surgery's Web site. See the "Practice Management" section, particularly under CPT for ENT, at www.entnet.org/Practice/Reporting-Nasal-Endoscopy.cfm.