Wiki Bilateral endoscopy with nasal cauterization

[dyoungberg]

The doctor performed a bilateral nasal endoscopy and electrical cauterization on the left nostril only. What is the correct way to bill this? I'm thinking 31238-50, but want to make sure I'm correct.

Thanks!

Debbie CPC-A
NW FL Surgery Center

 

[daknaack]

Hi Debbie,

31238 can be billed bilaterally, but if your doctor only performed the endoscopic electrocautery on the left side, I would say that you shouldn't apply the 50 modifier. It wouldn't be considered a bilateral surgery since he/she did not perform it on the right side as well.

Dana CPC

 

[jessica81680@comcast.net]

If I were coding this, I would start with 31231 (nasal endoscopy) without a 50 modifier, since the code can stand alone as a bilateral code. For the cauterization, I would use 30901 (cauterization of a nasal bleed) and add both a 51 modifier and a 59 modifier to indicate a separate procedure.

 

[daknaack]

I would still stick with 31238 since that incorporates both the endoscopic approach and the electrocautery.
Trying to bill out two separate procedures when there is one cpt code that encompasses the entire procedure would most likely lead to a denial.