Otolaryngology Coding Alert

Question: My otolaryngologist performs endoscopic ethmoid polypectomy, endoscopic total ethmoidectomy, open antrotomy, and open sphenoid polypectomy. May I report each procedure or does CMS bundle any of the codes? Should I use any modifier other than modifier -51?
 
Louisiana Subscriber

Answer: The National Correct Coding Initiative (NCCI), version 10.2, bundles only one of the code sets that you should report. Total ethmoidectomy code 31255 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) includes 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) for a same-side biopsy, polypectomy or debridement. CMS bases the edits on 31237's separate procedure descriptor. When your otolaryngologist performs 31237 on the same side as a more extensive sinus surgery, you should report the functional endoscopic sinus surgery (FESS) only, not the ethmoid polypectomy (31237).

But, if the surgeon performs the total ethmoidectomy on the patient's right side and removes a polyp from the left ethmoid, you may report the separate-side polypectomy (31237) in addition to the ethmoidectomy (31255).

No edits exist for the other procedures your otolaryngologist performs, the antrotomy (31020, Sinusotomy, maxillary [antrotomy]; intranasal) and sphenoid polypectomy (31051, Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp[s]). So, you do not need to use a modifier other than modifier -51 (Multiple procedures) on the remaining subsequent operations.

You should report the total ethmoidectomy, antrotomy (31020) and sphenoid polypectomy (31051) and possibly the ethmoid polypectomy in descending relative value unit (RVU) order. After the highest valued primary procedures, append modifier -51 to subsequent codes to indicate you are billing for multiple procedures.

If your otolaryngologist performs the total ethmoidectomy and polypectomy on the same side, you should report:
  31051 -- sphenoid polypectomy (13.62 RVUs) 31255-51 -- total ethmoidectomy (11.69 RVUs) 31020-51 -- antrotomy (6.69 RVUs).

For opposite-side ethmoidectomy and polypectomy, you should append modifier -59 (Distinct procedural service) to 31237 to indicate a separate side. Depending on payer, you may also need to add body-side indicators (-LT, Left side; -RT Right side). If your otolaryngologist performs the ethmoidectomy on the right side and removes polyps from the left ethmoid, you should bill:
  31051 -- sphenoid polypectomy (13.62 RVUs) 31255-51-RT -- right total ethmoidectomy (11.69 RVUs) 31020-51 -- antrotomy (6.69 RVUs) 31237-59-LT -- left ethmoid polypectomy (5.14).