Wiki New sinus surgery codes

[rytophmorg@yahoo.com]

Hello, I am confused on how to code the new sinus codes. The Doctor performed 31276/50, 31255/50,31287/LT AND 31256/50 . I am bundling the 31255 & 31287 as 31257 but I am not sure how to code it as the 55 is a 50 and the 85 is LT? I am new at coding and teaching myself as I go along. Thank you to anyone who can help me.

 

[cpc2007]

Hi

These new sinus surgery codes definitely get confusing when you have procedures on the frontal, ethmoidal, and sphenoidal sinuses during the same case. It's even harder when what is performed on each side is not the same. There is sometimes more than one way to code the procedure which could be "right" but I typically look to code the surgery in a way that is best for the provider and cleanest from a claim perspective.

In your particular scenario, I would consider coding 31253.50 (for the bilateral total ethmoidectomy and bilateral front sinusotomy which happens equally on both sides). Then tack on the 31287.LT for the sphenoid work on the left and 31256.50 for the maxillary work on both sides.

Since the codes are unilateral though, another valid way to code this would be 31257 (with the LT modifier) for the combined work of the total ethmoidectomy and sphenoidotomy on the left; 31253.RT for the combined ethmoidectomy and frontal sinus work on the right; 31276.59.LT (for the stand-alone frontal sinusotomy on the left); and 31256.50 for the maxillary sinuses. I find the first version a little cleaner and it avoids having to bypass a CCI edit, but both are technically correct.

I hope that helps - have a good night!

Kim
www.codingmastery.com

 

[pwald614]

new sinussurgery codes

So, I work for an ENT Dr. who is owned by the hospital. I am having trouble getting them to see that 31253 and 31257 shouldn't be billed together unless they are on separate sides. I have a surgery that was bilateral total ethmoidectomy, bilateral balloon frontal sinusotomy, and bilateral sphenoidotomy. I had gone to a Karen Zupko course who also stated that it would be double billing the total ethmoidectomy if we billed 31253 and 31257. They said Encoder allows it and they won't change their mind. I have received so many denials from Insurances because of the incorrect billing and they still won't believe me! I am printing this out to show them this also.