Otolaryngology Coding Alert

Question: Can the nasal endoscopy codes 31255, 31295, and 31297 be used with modifier 50? Can we include them on the same claim as 31296?

Maine Subscriber

Answer: According to CPT^® guidelines, at beginning of the endoscopy section, “Codes 31233 - 31297 are used to report unilateral procedures unless otherwise specified.” That means you should be able to append modifier 50 (Bilateral procedure) to the endoscopy code if the physician documentation supports it.

The codes this guideline applies to include:

• 31255 – Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior)
• 31295 – Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (e.g., balloon dilation), transnasal or via canine fossa
• 31296 – Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium (e.g., balloon dilation)
• 31297 – Nasal/sinus endoscopy, surgical; with dilation of sphenoid sinus ostium (e.g., balloon dilation).

The latest Correct Coding Initiative (CCI) edits allow you to report any of these codes on the same claim. Just be sure to have thorough documentation so the services your physician performed are clear to the payer.