Wiki Drug-Induced Sleep Endoscopy

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suec

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See other threads concerning this procedure and could use help to resolve coding discussion. A drug-induced sleep endoscopy was done with a b/l tonsillectomy. Diagnosis are hypertrophy of tonsils and OSA. Drug induced sleep endoscopy was done to identify the level of collapse. Procedure: The flexible fiberoptic scope was used to visualize the nasal cavities & the nasopharynx, result was anterior-posterior collapse of the palate. In the oropharynx showed anterior-posterior collapse of the tongue. Glottis appeared normal. Tonsillectomy then performed. My thought is CPT code 31575 is the code for drug induced sleep endoscopy, Laryngoscopy, flexible, diagnostic, because the documentation states the glottis was normal. Others think 92511 diagnostic nasopharyngoscopy with endoscopy, views the surface area extending from the posterior edge of the soft palate to the nasopharyngeal wall, including the eustachian tube. (not coded with the tonsillectomy code) Can anyone provide clarification? Thank you!
 
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CPT® codes designated as “separate procedures” are considered to be incidental and bundled with any related comprehensive/major procedure when performed during the same session, through the same incision, and/or at same anatomic site.

CPT 92511 is a "separate procedure" and is limited to the "nasopharyngeal" area, your provider took the exam down to the glottis which is part of the larynx consisting of the vocal cords, etc... CPT 31575 is a "laryngoscopy" and due to the nature of it's approach thru the nasal cavity, the exam includes the nasopharyngeal area as well as the laryngeal area. CPT 31575 would be the appropriate code for a "sleep endoscopy". You will want to append modifier 59 (due to the tonsillectomy) and be sure to assign your sleep apnea ICD10 code to this procedure.

Jennifer
Coding Analyst
 
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I do not agree that a 59 modifier would be used to bill both scopes. Think about it, which modifier would you apply, XS, XE, XP or XU. Some would say XU because the other three do not apply but there is nothing that makes these two scopes unusual and so you cannot even say that XU applies. The evaluation of the nasopharyngeal area is like a “drive by” when doing the laryngoscopy. If none of the X modifiers apply, the 59 modifier cannot apply and cannot be used.

There is no justification for a 59 to bill the 92511. The performance of the 31575 includes looking at everything all the way down to the larynx. The only time you would use the 59 modifier on these two codes is if you performed them at two different encounters.

A drug induced sleep endoscopy (DISE) is coded 31575 and it is usually being performed to evaluate a patient for an inspire sleep system. I am not sure your diagnosis, but if it is for an inspire sleep system, the diagnosis would be the appropriate sleep apnea diagnosed for the patient.
 
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Thank you both for your responses. I did clarify with the physician that the glottis was viewed. Used CPT 31575 for the drug induced sleep endoscopy. And yes it was for the inspire sleep system and sleep apnea was the diagnosis.
 
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Do you know if you got paid for the 31575? We bill that with a T&A or a tonsillectomy and get denied for the scope. Providers are doing it for sleep endoscopy and the 31575 is always denied inclusive
 
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