Otolaryngology Coding Alert

Question: In the July 1999 Otolaryngology Coding Alert on page 7, there was a question concerning how to get paid for a fiberoptic direct laryngoscopy. The procedure codes were 31575 and 31231 as well as billing for the consultation. We bill these charges with a modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) for evaluation and management services on the same day, but Medicare will pay only for 99244 (office consultation, comprehensive history and examination; medical decision-making of moderate complexity) and 31575. Why? And how can I get them to pay 31231?

Anonymous Michigan Subscriber

Answer: Code 31231 (nasal/sinus endoscopy) is bundled into the more extensive 31575 (flexible, fiberoptic laryngoscopy, diagnostic). Medicare will not pay for both procedures if they are performed during the same operative session, unless the documentation clearly indicates that the scopes were performed either at different sites or at separate times. Should that be the case, modifier -59 (distinct procedural service) should be attached to the 31231.

Otolaryngologists should remember that using modifier -59 (which overrides most of the Correct Coding Initiative edits) also calls attention to the claim and is considered a red flag for audit.