Otolaryngology Coding Alert

Question: The doctor used an endoscope to remove a posterior nasal lesion. May I report 30117 for this procedure? Must the code descriptor specify -endoscopic- to be the correct choice?


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Answer: In this case, choose 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) because it best describes the procedure your ENT performed (polypectomy describes an endoscopic lesion removal).

Code 30117 (Excision or destruction [e.g., laser], intranasal lesion; internal approach)--although higher-paying than 31237--describes an intranasal excision without use of an endoscope. Code 30117 pays more than 31237 because the former has a 90-day global period, while the latter has a zero-day global period. Thus, 30117 includes greater postoperative care.

CPT coding guidelines warn against choosing a -next best- code for any procedure. You should never substitute an equivalent -open- code to describe an endoscopic procedure. You should always choose an appropriate endoscopic procedure code.

If the ENT performs an endoscopic procedure for which there is no dedicated CPT code, you should choose an unlisted-procedure code (for instance, 31299, Unlisted procedure, accessory sinuses).