Wiki 31231 during post op period...Please help

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kerileigh

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If a patient just had sinus surgery and is following up post op . Is it appropriate to bill for the nasal endo to evaluate healing and to remove splints? There is no debridement nor bx being taken.
 
Post op period

During post op period there should no charges unless there is something performed that is not related to the surgery.
 
that was what i thought should happen, however the MD states that it is billable because of the work rvu involved
 
Please remember that the endoscopic sinus surgery codes have zero global, 31276, 31255, 31254, 31267, 31256, 31288, 31287; so, nasal endoscopy (31231) done post-operatively would be billable......if your surgeon performed any other procedures in conjunction with the sinus surgery, such as, septoplasty (30520) and/or turbinectomies (30130, 30140), then you add a 90 global to the surgery; if your surgeon does a nasal endoscopy post-operatively with that scenario, then you need know if the scope was done to check the healing of sinuses or done to remove splints from the septoplasty, etc... It's a gray area and one you need to have good documentation on, the scope is still billable in this scenario using modifier 79 if applicable.

Jennifer
CT ENT
 
thank you Jennifer. Most of the post op scopes are to evaluate the healing/remove splints. Our corporate office is saying that they should not be billable since they are in a post op period and i am trying to help the physician.
 
As I previously stated, endoscopic sinus surgery has zero global but when you perform the septoplasty and/or turbinate procedure(s), this adds a 90 global; as we all know, splints for septoplasty can be removed without an endoscope, so therefore, scopes are used to address the sinuses and can be billable if your MD documents appropriately; just remember to add modifier 79 and use the appropriate sinus dx code, if you bill with septum/turb code you will be denied.

Jennifer
CT ENT
 
Post Op Endoscopies are Staged Procedures

I recommend modifier 58 for post-op endoscopies. Because the procedure IS related to the original surgery, and is more extensive and anticipated.
Please see document at the link below.

https://www.modahealth.com/pdfs/reimburse/RPM009.pdf

Reporting Postoperative Sinus Endoscopies and/or Debridements
1. When all of the procedure codes performed at the original surgical session have zero follow-up global days, then postoperative sinus endoscopies and/or debridements should be reported without appending modifiers 58, 78, or 79.
2. When any one of the original surgical procedures carry a global period:
a. Modifier 79 is not valid when attached to CPT codes 31231, 31237, S2342 for any sinus endoscopy and/or debridement performed within that global period. The use of modifier 79 in this circumstance to characterize 31231, 31237, or S2342 as ?unrelated? to the procedure code with the global period is inaccurate, and an inappropriate use of modifier 79. The sinus endoscopy or debridement is related to the surgical session with the global period, regardless of which procedure code the surgeon deems the endoscopy/debridement to be related.
 
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