Otolaryngology Coding Alert

Question: Our physician performed a partial ethmoidectomy with nasal endoscopy on one side and a total ethmoidectomy on the other side during the same surgical session. How should I code this in order for the carrier to reimburse us for both procedures?

New Jersey Subscriber

Answer: Modifier -59 (Distinct procedural service) is the key to getting paid for 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) and 31255 (... with ethmoidectomy, total [anterior or posterior]) when performed on separate sides of the body during the same surgical session.

You should report 31255 first, then report 31254-59 and sequence it second. If your carrier refuses to recognize modifier -59, appeal. Under the circumstances you describe, you should be able to justify separate reimbursement with the appropriate documentation. Double-check to be sure your physician included notes indicating that the procedures were performed on separate sides. And if you need to append additional modifiers (such as -LT [Left] and -RT [Right]) to indicate the separate locations, remember to append modifier -59 first, because it is the primary modifier.