Otolaryngology Coding Alert

Question: The otolaryngologist performs nasal e ndoscopy on a patient with epistaxis to locate the source of the bleeding, and then withdraws the scope and cauterizes the patient’s anterior nose extensively. We reported codes for both the scope and hemostasis, but the claim was denied. How should this be coded?

Nevada Subscriber

Answer: In this case, submit only the surgery code 30903 (Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method). While tempting, you shouldn’t bill both the diagnostic procedure and the surgery.

Why? You shouldn’t code 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) along with 30903 because the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits bundle control of epistaxis codes 30901-30905 into diagnostic nasal endoscopy code 31231. Thus, you should report the higher-valued code when your otolaryngologist performs diagnostic endoscopy prior to cautery and/or packing.

Pay attention: This is a backward edit. NCCI usually bundles the diagnostic procedure into the surgery, not the other way around.

Careful: All hemorrhage control codes except 30901 (Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method) pay more than endoscopy (31231). So, when your ENT uses an endoscope to examine the nasal passages to determine the location and severity of the bleeding, withdraws the scope, and then treats the epistaxis (30903-30905), you should submit the surgical procedure code. But when they use diagnostic endoscopy before simple cautery (30901, the lowest-valued procedure), report the endoscopy code because it pays more.