Examine Nasal Endoscopy Claims for Compliance

A Comprehensive Error Rate Testing contractor special study of Medicare Part B claims for diagnostic nasal endoscopy, submitted between April and June 2014, showed that most improper payments were due to insufficient documentation. The specific CPT® codes targeted in the study were:

31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)

31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via interior meatus or canine fossa puncture)

These codes include inspection of the interior nasal cavity, middle and superior meatus, turbinates, and spheno-ethmoid recess.

Documentation Checklist

To process a claim for nasal endoscopy, Medicare administrative contractors require four essential elements to be documented in the medical record:

o   The correct date of service

o   The reason for the procedure

o   The results of the procedure

o   The physician or other qualified healthcare professional’s signature (and/or signature log, or attestation)

According to the American Rhinologic Society (ARS), some common reasons for diagnostic nasal endoscopy are to:

• Evaluate for chronic sinonasal symptoms unexplained by anterior rhinoscopy
• Assess interval response to medical or surgical therapy in patients with chronic sinusitis and recurrent acute sinusitis
• Monitor for recurrence of nasal polyps
• Evaluate and manage epistaxis
• Perform endoscopically guided cultures
• Assess facial pain suggestive of rhinogenic origin
• Evaluate clear rhinorrhea suggestive of cerebrospinal fluid leak
• Perform initial diagnosis and interval surveillance for sinonasal neoplasms

Retain Payment

If your claim doesn’t meet these requirements and is consequently denied, all is not lost. If you take the time to correct the errors, you may be able to obtain or retain payment. For example, if the submitted office note was partially illegible and not signed, submit a transcribed version of the documentation with the original version and an attestation from the provider. Once the payer has all the facts, it can process the claim accordingly.

Resources:

CMS Provider Minute

Medicare Quarterly Provider Compliance Newsletter, Vol. 5, Issue 4, July 2015

ARS Position Statement – Diagnostic Nasal Endoscopy (31231)

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Renee Dustman

Executive Editor at AAPC

Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

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