Let me give you some background since you may not know why this code gets denied.
The endoscopic removal of a concha bullosa (31240) is really work on the middle turbinate and I am told that it is a very fast procedure. We know that excision or resection of the middle turbinate is considered incidental to FESS as it is for access as well as opening up the sinuses. So, we cannot code or bill for excision or resection of the middle turbinates. The turbinate codes used to be “any turbinate” and payers would deny them, thinking that they were being used for middle turbinate excision. Then CPT changed the wording for the turbinate codes to include only inferior turbinates, which allowed for smoother reimbursement of the codes.
Now we come to 31240, which is NOT bundled with 30130/30140 or any of the FESS codes. This means that one should be able to code and bill for 31240 with no modifier and be paid. But many payers feel that 31240 is not much more than the excision of the middle turbinate that they have an edit on 31240 and deny it. I teach Otolaryngology coders that if their surgeons do an endoscopic removal of the concha bullosa, they can code 31240 or if performed bilaterally, 31240-50, but if the payer denies the code, do not bother appealing it as there really is no basis for appealing the opening up of the sinuses at the middle turbinate as it is access to all of the sinuses.
So, now I hear that some people are coding 31240 with an XU modifier for Separate, Unusual (one of the modifier 59 replacements) and are getting paid for 31240 services fairly regularly. This is like hearing that someone put a 59 modifier on two bundled codes so that they both could be paid with support for the 59 modifier and separate nature of the two procedures. How can those putting the XU modifier on 31240 justify the separate and unusual nature of the concha bullosa from the normal resection of a concha bullosa to support the XU modifier? Regular use of the XU modifier with a code is saying the exact opposite, that it is not separate and that it is not unusual, it is common. So, although the practices are getting paid for the 31240-XU or 31240-50-XU, those claims would not hold up on audit, refunds would be due and the practice would be looking at claims of fraud.