Otolaryngology Coding Alert

Question: Our ENT physician performed an endoscopy with concha bullosa resection (31240), along with an inferior turbinate excision (30140). Someone from another practice told me that they’re able to collect for both procedures if they use the 59 (Distinct procedural service) or XU modifier (Unusual non-overlapping service), and in those cases, 31240 is always paid. Is this possible? We’ve gotten denials when we’ve tried to report these together in the past.

Codify Subscriber

Answer: If you’re getting denials for 31240 (Nasal/sinus endoscopy, surgical; with concha bullosa resection) when performed during the same patient encounter as 30140 (Submucous resection inferior turbinate, partial or complete, any method), you’re not alone. But a modifier won’t always be the key to reimbursement in this situation.

Your first step toward payment for 31240 is clear documentation of the endoscopic resection of the concha bullosa, which is located by the middle turbinate. Explain to the otolaryngologist that describing all the work involved in the added procedure in the operative note will allow you to pinpoint the separate procedure, code for it appropriately, and get them paid for the procedure.

If the otolaryngologist performs the endoscopic concha bullosa resection on the inferior turbinate rather than the middle turbinate, the modifiers may help you explain that.

Tell your otolaryngologists that solid documentation can make the difference between 31240 payment on appeal and nonpayment. The surgeon should document the endoscopic excision of the concha bullosa well. The operative note should show all the work involved in the added procedure.

Expect the payer to subject 31240 to multiple-procedure payment reduction rules, reducing payment by 50 percent when it’s billed as a second procedure.