Diagnostic Endoscopy Codes Offer Reimbursement Opportunities
Published on Sat Sep 01, 2001
Improper coding for diagnostic endoscopies can sometimes result in the loss of significant reimbursement. Among the reasons for this are using the lower-level 31231 code (nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) for all diagnostic endoscopies. Depending on what the otolaryngologist did and documented, it may be appropriate to bill either 31233 or 31235 (see definitions below) if the diagnostic endoscopy went beyond the areas covered by 31231 and scoped the maxillary or sphenoid sinuses.
Several factors make billing 31233 (nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy [via inferior meatus or canine fossa puncture]) or 31235 (nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy [via puncture of sphenoidal face or cannulation of ostium]) complicated. First, the documentation must be precise, not only identifying the specific anatomic areas viewed by the endoscope but also detailing how access to the sphenoid or maxillary sinus was achieved.
Second, 31233 and 31235 may be confused with their surgical counterparts, 31256 (nasal/sinus endoscopy, surgical, with maxillary antrostomy) and 31287 (nasal/sinus endoscopy, surgical, with sphenoidotomy). This can result in downcoding (for example, a 31256 to a 31233) and receiving less payment than the otolaryngologist should have obtained. Upcoding (31235 to 31287) may also occur. To use these codes correctly, clinical differences must be understood.
What Is Diagnostic Sinus Endoscopy?
Endoscopic codes 31231, 31233 and 31235 describe diagnostic procedures. "These three codes are about viewing, not doing," says Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing company in Lakewood, N.J. "The procedures described by these codes evaluate, but do not treat, the patient."
The basic diagnostic endoscopy code, 31231, describes an endoscopic inspection of the nasal cavity and turbinates, as well as the inferior meatus and the middle meatus, all of which typically are easily accessed through the nose.
"This is not the case for 31233 or 31235," Cobuzzi says. "These diagnostic procedures are more serious because there is no easy access to the maxillary or sphenoid sinuses. Unless the patient has had previous sinus surgery and, as a result, there is an opening that allows easy access to the sinus, the procedure usually is performed in the operating room, especially a 31235."
If the patient does not have an existing opening, the otolaryngologist may need to puncture the inferior meatus or the canine fossa for a maxillary endoscopy, Cobuzzi adds.
Similarly, to inspect the sphenoid sinus(es) of a patient who does not have an opening, the otolaryngologist may need to puncture the sphenoidal face (bone) or insert a tube into the sinus opening, i.e., cannulate the ostium.
Note: Although the sinusoscopies described in 31233 and 31235 are surgical procedures (because they involve puncturing the inferior meatus or the sphenoidal face), the procedure [...]
