Stuart, Florida
Best answers
31231, 31575

In my experience in order to bill one over the other or both for one visit, certain criteria needs to be met. Documentation should state what scope was used, and what anatomic sites were examined. Generally, 31231 is used to evaluate the the nasal passages, sinuses, turbinates, middle meatus, and choana. In 31575, the scope is passed further down to evaluate vocal cords, hypopharynx, base of tongue, pyriform sinus, and vallecula.

In RVU order, 31231 is higher than 31575. In my experience, when billing for both procedures on the same day, our doctors have to document the use of two separate scopes (rigid or flexible) and two different anatomic sites in order to apply the -59 modifier appropriately. They also have to document the medical necessity to perform both procedures on the same day. It is rare for our drs to need to do this but I have seen it documented correctly. Usually the claims are submitted with two different diagnosis codes on each procedure code. For example, the patient had chronic sinusitis upon performance of the nasal endoscopy, and vocal cord polyps and a suspicious lesion on the vocal cords when they did the laryngoscopy.

If you choose to bill 31231 and 31575, the modifier 59 should be appended to 31231.

I hope this helps :)

on same date of service phy done 31231,31575 both scopy for diagnostic purposewhich one can we use with E/M..kindly share your views


Best answers
My doctors often use the same scope for both nasal and laryngeal endoscopy, so I can't generally bill for both. The previous comment is correct, the 31231 has a higher RVU. I've also heard in a seminar before (I'll have to dig up my documentation) that the scope that goes the furthest into the body should be billed, which would be the 31575. I, however, tend to lean more toward which scope pertains more to the encounter. If the patient is having chronic sinus issues in addition to throat problems, but the doctor orders a CT of the sinuses and prescribes a nasal spray, I feel like the nasal endoscopy is the more pertinent scope to the visit. Hope that helps!