Otolaryngology Coding Alert

Question: How should I report nasal endoscopy "with cultures"? Is this the same as nasal endoscopy with biopsy? Answer: A culture involves obtaining a swab from visible sinus drainage or from the middle meatus without removing tissue. In contrast, a biopsy (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) requires removing tissue from living patients for diagnostic examination. In your example, the otolaryngologist performs a nasal endoscopy and takes a swab, not tissue, from the internal nose. Therefore, you should bill a nasal endoscope with cultures as 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]). Remember that this is a unilateral or bilateral procedure. So, if your otolaryngologist scopes both sides of the nose, you should report only 31231. In addition, 31231 is a separate procedure, which means you should report it when performed alone or with other unrelated procedures or services. For instance, if the otolaryngologist performs a significant, separately identifiable history, evaluation and medical decision-making, which leads him to perform the scope, you should assign the appropriate E/M code, such as 99211-99215 (Office or other outpatient visit for the E/M of an established patient) appended with modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) and 31231. You should include the culture in the medical decision-making part of the E/M service.