Wiki 31237's done during global period

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karenwelsh

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Is anyone having problems with reimbursements for this when a pt comes to the office after surgery? We aren't getting paid for these and some patient's are requiring 1-2-3 scopes after surgery -- ins co's are saying part of global.

I've heard that if you add modifyer 79, you'll get paid. We've re-filed with this modifyer and it's not helping.

Thanks for any advise from you more experienced coders out there!

Karen
 
Hi Karen,
Have you received any replies to this post? I am new to ENT and am questioning billing for endoscopies during the global period. Have you always billed for these and are just starting to get denials?
Thanks, Mary
 
After endoscopic sinus surgery (codes 31254 - 31288) we bill 31237 when appropriate with NO modifier because those codes have no global period. We do not have a problem with payment. Is the 31237 being bundled with another procedure by your insurance carrier?
 
No, nothing is being bundled when billing the 31237 -- only billing this code. We keep getting that this is included in global (?) -- I've just gotten certification and am stumbling thru this process, so I thank you:) for your response. We'll see what happens next time with no modifyer or any other CPT
 
billing 31254 & 31237

Hey Everyone,

I need some help. I work for an ENT, whom performs a lot of 32154 revision of the ethmoid sinus. we are having a hard time getting the 31237's paid after the surgery, even though its required by the dr for debridement and ensure what was performed is working.. can anyone help me with this issue. Also can both codes be billed together on the same DOS???????
 
Hi, I code for a group of ENT physicians. You cannot bill 31254/31255 on the same day as 31237. However, you should be able to bill 31237 postop as long as your sinus surgery did not included any other procedures that have a global period. A lot of times, we do a septoplasty with the sinus surgery and it has a 90-day global period. You would then need to file modifier 79 on 31237 when done post-operatively to show that it is not related to the portion of the surgery that is under a global period. Hope this helps!
 
Nasal endoscopy of the sphenoid is the only sinus code that has a global, which is 50 days. In this case, I would use -58, and only a sinus code (473.x)

That is how I bill out the post op debridement, and we are not having any payer issues. Let me know if this helps.
 
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