Otolaryngology Coding Alert

Question: A patient has septoplasty and turbinate surgery. Three weeks after the surgery, he experiences nosebleeds. The physician decides to perform nasal endoscopy with control of epistaxis. What modifier should be appropriate to use?

North Carolina Subscriber

Answer: Medicare does not allow for billing or coding for postoperative complications unless they require a return to the operating room/procedure room. However, AMA CPT® specifically states that treatment of postoperative complications and exacerbations are not included in the surgical global.

The ENT usually performs 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) in the office, and in the operating room. So, for a Medicare patient, the endoscopic control of the epistaxis -- which is related to the surgery -- would not be billable or coded. If the patient is not a Medicare patient and the surgery is related to the septoplasty/turbinectomy, AMA CPT® says the care is billable. The only way to get the claim paid in the global period is to use a modifier which will break the global period. For a non-Medicare patient, the modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) would be used, indicating that it is an unrelated procedure. The diagnosis would be postoperative hemorrhage, 998.11.

If the epistaxis is entirely unrelated to the surgery which created the global, you can bill 31238 with modifier 79 to any payer including Medicare. The diagnosis would be epistaxis, 787.7.