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Otolaryngology Coding Alert

Maximize Your Endoscopic Reimbursement by Avoiding These Pitfalls

Published on Mon Oct 26, 2009

Order your codes incorrectly on your claim, and you may miss out on $104. For functional endoscopic sinus surgeries (FESS) documentation, global periods, and modifiers, you need to be extra vigilant if you want to recoup the highest possible ethical reimbursement the first time you submit your claim. Dodge these three pitfalls, and your claim will sail through your payers' hands, no questions asked. Pitfall 1:You Don't Verify Endoscopic Procedure Otolaryngologists use FESS (31237-31288) as a sinus surgical method. The term "functional" distinguishes this type of endoscopic surgery from nonendoscopic, more conventional sinus surgery procedures. The main  purpose of FESS is to restore normal drainage of the sinuses. Warning: Before you apply nasal/sinus endoscopy codes (31231-31294), make sure your otolaryngologist performed and documented endoscopic procedures. Auditors reported encountering a few cases in which physicians performed sinus procedures via Caldwell-Luc antrotomies or frontal sinusotomies and not via endoscopy (or at least [...]
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