Wiki Endoscopic left choanal atresia repair with stenting

[karen1123]

Is it appropriate to bill 31231 with 30540 (Repair of choanal atresia,intranasal)? The right side of the nose was examined to confirm patent choana prior to surgery for the left side. Insurance denied as inclusive to 30540, but wondering if appeal is in order.

 

[Ritika]

31231 with 30540

Hi,

I think you can bill 31231 with 30540 as 30540 is for repair of choanal atresia however 31231 is for nasal endoscopy which is diagnostic in natur.They both are differnt procedure hence can be billed seperately.

 

[JenniferB7]

CPT 31231 is designated as a "separate procedure", which means that it is considered inclusive to a more major procedure on the same body area/system. If 31231 was used to evaluate the choana, then it is considered inclusive to 30540 and not separately reportable.

From the CPT Surgery Guidelines:

Some of the procedures or services listed in the CPT codebook that are commonly carried out as an integral component of a total service or procedure have been identified by the inclusion of the term "separate procedure." The codes designated as "separate procedure" should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.

However, when a procedure or service that is designated as a "separate procedure" is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific "separate procedure" code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).​

Hope that helps!