Wiki Billing post-operative scopes

[ckemp7670]

I'm wondering if anyone out there is billing for post-operative scopes, which modifiers they are using, and if the charges are being paid? We have questions about CPT 31231 and 31575. Does anyone have any insight to these scopes? Thank you in advance!

Carol K.

 

[nerdiejae]

Both of these can be billed separately during the post op period and they are paid as long as authorization was obtained (for insurances that require it).

 

[rytophmorg@yahoo.com]

Both of these can be billed separately during the post op period and they are paid as long as authorization was obtained (for insurances that require it).

what modifier are you using?

 

[cpc2007]

The answer to your question will depend on the indication for performing the scope and your payer guidelines. In the NCCI Policy Manual which is published by Medicare, in chapter 1, section C.14, the guidelines state "Additionally the global surgical package includes all medical and surgical services required of the surgeon during the postoperative period of the surgery to treat complications that do not require return to the operating room." So for Medicare and those payers following Medicare guidelines (which is a growing number of mainstream commercial insurance companies) if you perform the scope postoperatively, the scope is performed for a complication (e.g,. bleeding) from the primary procedure, and you do not take the patient back to the OR to perform the scope but instead perform it bedside at the hospital or in your office, you cannot be paid for the postoperative scope. Not all payers follow Medicare guidelines and not all postoperative scopes are performed for postoperative complications. So these details will affect the coding and whether you can be paid, but I wanted to share one reason a payer may not reimburse for a postoperative scope.

I hope that helps -have a great night.

Kim
www.codingmastery.com

 

[clbcarey@comcast.net]

31575 with modifier 58-staged or related procedure

 

[ENTcoderConnecticut]

31575-79 in particular if there a shorter postop period which seems to be the case with the sinus surgeries.

 

[jackjones62]

Endoscopic Sinus Surgeries as well as Laryngoscopy procedures are zero global, no modifier is necessary unless there are other procedures such as septoplasty (30520) or turbinectomies (30130,30140) performed as well; these codes carry a 90 day global, therefore a modifier 79 needs to be applied. Same rule applies to any laryngoscopy procedure, though I can't recall that we ever billed out these types of procedures with another procedure with a 90 day global, but never say never. Nerdiejae is correct, these post-operative codes require prior authorization, we routinely obtained them at the time we got prior auth for the surgery.

Jennifer
Coding Analyst

 

[b.cobuzzi]

Carol K,

You need to indicate what procedures you are post operative from in order to answer your question.