Pulmonology Coding Alert

Question: A patient presented to our pulmonology practice for a nasal endoscopy on the right side. The pulmonologist performed a polypectomy and submitted tissue for biopsy.

Can we report 31237 twice on one side to report the biopsy and debridement?

Florida Subscriber

Answer: No, you may report 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)) only once. The biopsy is considered inherent to the polypectomy, so if the pulmonologist or another qualified healthcare professional (QHP) performs a unilateral (one side) polypectomy and submits tissue for biopsy, report 31237 only once.

You may append appropriate modifiers to indicate the side of the body on which the provider performed the procedure. This code is a unilateral service, so appending the code with RT (Right side) specifies the pulmonologist performed the service on the patient’s right nostril.

Additionally, if the physician performed the procedure on both sides of the patient’s body, then you could append 31237 with modifier 50 (Bilateral Procedure) or RT/LT (Left side) to indicate the physician performed the procedure bilaterally. Of course, you should check your individual payer’s preferences to confirm which modifiers to use.