Otolaryngology Coding Alert

Question: After a septoplasty for a deviated septum, turbinectomy via excision for hypertrophy, total ethmoidectomy for ethmoidal sinusitis (J32.2), and maxillary antrostomy for maxillary sinusitis (J32.0) an otolaryngologist performs endoscopic sinus debridement. Documentation indicates the debridement was to remove crusting following sinus surgery in order to prevent infection and keep the airway patent. What codes are reported for the surgeries, and can I also code the debridement?

Louisiana Subscriber

Answer: You’d use the following codes to report the septoplasty, turbinectomy, ethmoidectomy, and maxillary antrostomy:

• 30520 (Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft)
• 30130 (Excision inferior turbinate, partial or complete, any method)
• 31255 (Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior))
• 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy)

Because the ENT performed the debridement for a reason (chronic ethmoidal and maxillary sinusitis) that is unrelated to the reason for the septoplasty and turbinectomy, you should report the debridement with 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)). Append modifier 50 (Bilateral procedure) if the debridement was done bilaterally.

In this case, the patient is being followed postoperatively for both 0-day global and 90-day global procedures, so you should append modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) to 31237 to indicate that the debridement is unrelated to the major procedures.

Go one step further: Include a note stating that “the debridement is unrelated to procedures 30520 and/or 30130-30140, diagnosis J34.2 (Deviated nasal septum) and J34.3 (Hypertrophy of nasal turbinates) on date of surgery xx/ xx/xxxx.” Additionally, make sure you report J32.0 (Chronic maxillary sinusitis) and J32.2 (Chronic ethmoidal sinusitis), as well as any other documented diagnoses that support the need for post-op sinus debridement.