Otolaryngology Coding Alert

Even modifiers 59 can't help you with 92511, 31231 bundle

Your ENT may perform several endoscopic procedures for the same patient on the same day under certain conditions, but you must be cautious when billing such services.

Example: Because the ENT may pass the flexible laryngoscope through the nose, she can examine the sinus area before the scope enters the larynx. In this case, you might argue that the doctor performs both a nasal endoscopy (31231, Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) and flexible laryngoscopy (31575, Laryngoscopy, flexible fiberoptic; diagnostic), but you may not code for both. Instead, you can only report the more extensive procedure (31575).

Let NCCI guide you: The National Correct Coding Initiative bundles 92511 (Nasopharyngoscopy with endoscope [separate procedure]) to both 31231 and 31575.

Watch modifier indicators: The NCCI edit bundling 31231 to 92511 specifies a -0- indicator, meaning that you cannot use modifier 59 (Distinct procedural service)--or any other modifier--to unbundle the edit for any reason.

The edit bundling 92511 to 31575, however, specifies a -1- indicator, which means that you may report 92511 with 31575 in certain circumstances.

Example: The ENT examines the nasopharynx using a scope and evaluates the larynx for a different problem later in the day. In this case, you could report 31575 and 92511 separately (with modifier 59 appended to the latter). Your documentation should specify the time that the ENT performed each procedure and must demonstrate unquestionably why the second scope was required.