Wiki sinus code 31231

[hallansmom]

I work for 4 ENT physicians and the following is the sinus portion of the op note. We are getting more denials for code31231. Please let me know if I should be submitting it with a modifier 52.

"Using a 30 degree Strotz-Hopkins telescope, the middle meatus was visualized and a 26 olive-tipped suction with Lukens trap attached was inserted into the maxillary sinus to take separate cultures from both maxillary sinuses. Afrin soaked pledgets were then placed into the nasal cavity on each side to provide hemostatis."

Any help would be appreciated........

 

[b.cobuzzi]

Was anything else billed for this encounter, Hallansmom?

Documentation for 31231 should include the topical anesthesia, and the findings from looking at the sinuses via the endoscope. You don’t have any of the components. Your doctor used the scope to assist in taking a culture, and that would be part of the EM unless you have medical necessity for the 31231 (why you need a diagnostic endoscope) and the performance of the diagnostic endoscope and the findings.

Many insurance companies deny the dx endoscope with an 25 modified EM, forcing the practice to send in the notes to show that the EM is supported as a Signifiant an separately identifiable EM with the separate procedure note. And if you don’t have that in your notes, you cannot appeal the denial. Without knowing what else was billed with the scope, I cannot give a full answer.

 

[hallansmom]

Was anything else billed for this encounter, Hallansmom?

Documentation for 31231 should include the topical anesthesia, and the findings from looking at the sinuses via the endoscope. You don’t have any of the components. Your doctor used the scope to assist in taking a culture, and that would be part of the EM unless you have medical necessity for the 31231 (why you need a diagnostic endoscope) and the performance of the diagnostic endoscope and the findings.

Many insurance companies deny the dx endoscope with an 25 modified EM, forcing the practice to send in the notes to show that the EM is supported as a Signifiant an separately identifiable EM with the separate procedure note. And if you don’t have that in your notes, you cannot appeal the denial. Without knowing what else was billed with the scope, I cannot give a full answer.

Thank you so much for responding.......Tubes were inserted into both ears and an Adenoidectomy/Tonsilectomy were performed as well.