Endoscopic Sinus Surgery Billing Considerations Clear Passages to Reimbursement
Published on Fri Mar 01, 2002
" Functional endoscopic sinus surgery (FESS) is a relatively common otolaryngological procedure that can be performed under a variety of circumstances, thus presenting otolaryngologists and their staff with special coding challenges.
The most commonly performed FESS procedures include:
31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)
31238with control of nasal hemorrhage
31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)
31255 with ethmoidectomy, total (anterior and posterior)
31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy
31267 with removal of tissue from maxillary sinus
31276 Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus
31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy
31288 with removal of tissue from the sphenoid sinus.
Codes 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) and 31238 ( ... with control of nasal hemorrhage) are set apart from the other procedures listed above in that biopsy, debridement, polyp removal (for 31237) and control of bleeding (for 31238) do not specify a particular sinus. Either procedure can be performed in the operating room or in the otolaryngologist's office.
Code 31237 is a separate procedure, which means it should not be billed when performed at the same time as more extensive sinus surgery. Code 31238 is reported when the otolaryngologist uses the endoscope not only to guide the packing process but also to control the bleeding.
Billing Considerations
1. If FESS is performed on the same day as a diagnostic endoscopy, bill for the FESS procedure only. A diagnostic endoscopy typically 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) often precedes any of the FESS procedures above. None of the three diagnostic endoscopy codes 31231, 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]) may be billed if FESS is performed on the same day, even if the diagnostic endoscopy led to the decision to perform the more extensive procedure. For example, if the otolaryngologist performs a diagnostic endoscopy with maxillary sinusoscopy (31233) that determines the need for a maxillary antrostomy (31256, Nasal/sinus endoscopy, surgical, with maxillary antrostomy), the otolaryngologist may perform the surgery then and there so that the patient does not have to make a second trip. However, only 31256 may be billed.
2. Use modifier -50 if the same procedure was performed on the right and left sinuses. Otolaryngologists probably perform more sinus services on both sides than on one side alone. However, because the basic diagnostic endoscopy code (31231) includes the words unilateral or bilateral"" in its descriptor" some coders believe that all sinus surgery includes both sides and that modifier -50 (Bilateral procedure) [...]
