Otolaryngology Coding Alert

Question: When an otolaryngologist performs a bilateral total ethmoidectomy, should I code each side? If so, should I report 31255 x 2 units or 31255-50? Why?

Georgia Subscriber Answer: You should code an ethmoidectomy (31255, Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]), like all functional endoscopic sinus surgeries (31233-31294), as a unilateral procedure. The only endoscopy code that you should count as a unilateral or bilateral procedure is diagnostic sinus endoscopy (31231, Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]). For all other endoscopy codes, report the surgery per side.
 
Check with the insurance company for advice on how it wants you to report bilateral procedures. Many commercial payers prefer that you bill two codes on separate lines:
  31255
  31255-50. In this case, modifier -50 (Bilateral procedure) informs the insurer that you are reporting a bilateral total ethmoidectomy.
 
Some payers, however, such as Medicare, Blue Cross Blue Shield (BCBS) and now Oxford, require a one-line claim:

  31255-50 with one unit.

When submitting claims this way, make sure you double the fee and track the reimbursement. For instance, BCBS sometimes misses modifier -50 and pays practices for a unilateral procedure.

Insurer Alert: Be extra vigilant in using the one-line submission when you bill bilateral ethmoidectomies to Oxford.

The payer recently started requiring a single-line entry and will not process any two-line bilateral claims.