Otolaryngology Coding Alert

Question: An otolaryngologist performed bilateral endoscopic sinus debridement for chronic frontal and ethmoid sinusitis during a septoplasty's global period. Should I code for the debridement?                                                                                                                                                               North Dakota Subscriber Answer: Because the sinus debridement is unrelated to the septoplasty, you may code the debridement (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]). To indicate the debridement is unrelated to the septoplasty's 90-day global period, append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 31237. But if the debridement is related to the septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft), you could not separately report 31237. Tip: Look for a different diagnosis from the original surgery's to determine whether 31237 is billable. The scenario you mention contains a diagnosis of chronic frontal sinusitis (473.1) and ethmoid sinusitis (473.2) for the debridement and deviated nasal septum (470) for the septoplasty. Don't miss: Code 31237 is a unilateral procedure. Because your case involves bilateral debridement, you should append modifier 50 (Bilateral procedure) to 31237 in addition to modifier 79. List the payment modifier first -- modifier 50 (bilateral procedures pay at 150 percent) -- and then the informational modifier (79). When filing to a Medicare carrier or payer that requires one-line bilateral submission, you would report the above claim as: CPT     Modifier      Diagnoses      Units 31237     50,79        473.1,473.2          1