Wiki I need help with Operative report please

[Strumble]

I am a new coder. I'm trying to code this operative report myself before asking for a supervisor's opinion. The procedures I have concluded are 31231-50 and 32167 LT,59. H05.20 and J01.01.

 

[sls314]

I am a new coder. I'm trying to code this operative report myself before asking for a supervisor's opinion. The procedures I have concluded are 31231-50 and 32167 LT,59. H05.20 and J01.01.

This isn't my normal specialty, but a few things jumped out at me:

The OP report says Chronic Rhinosinusitis, but the diagnosis code you chose is for Acute Recurrent Maxillary Sinusitis.

31231 and 31267 cannot be billed together. There is an NCCI edit and a modifier is not allowed to override the relationship.

The definition for 31267 is "nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus." The endoscopy is already included in the definition of the code.

(By the way, even when 31231 is billable, you'd never use a 50 modifier. The definition of the code is "Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)" - you wouldn't use a modifier to indicate a bilateral procedure, because by definition the code already includes bilateral.)

 

[Strumble]

This isn't my normal specialty, but a few things jumped out at me:

The OP report says Chronic Rhinosinusitis, but the diagnosis code you chose is for Acute Recurrent Maxillary Sinusitis.

31231 and 31267 cannot be billed together. There is an NCCI edit and a modifier is not allowed to override the relationship.

The definition for 31267 is "nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus." The endoscopy is already included in the definition of the code.

(By the way, even when 31231 is billable, you'd never use a 50 modifier. The definition of the code is "Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)" - you wouldn't use a modifier to indicate a bilateral procedure, because by definition the code already includes bilateral.)

Thank you for your help. I did see that in ICD 10 Chronic Rhonosinusiits refers to sinusitis. Chronic doesn't appear in the index so that's why I chose what I did. I originally thought the same with the 31231 and 31267 but the diagnostic was bilateral and the surgical was only left sided. The coding notes say you can't bill together if ipsilateral. I wasn't sure if that applied since the right side was explored. The surgeon had coded both. Definitely thank you for the mod info, I did miss that. So I should question the two cpt codes billed?

 

[sls314]

Thank you for your help. I did see that in ICD 10 Chronic Rhonosinusiits refers to sinusitis. Chronic doesn't appear in the index so that's why I chose what I did. I originally thought the same with the 31231 and 31267 but the diagnostic was bilateral and the surgical was only left sided. The coding notes say you can't bill together if ipsilateral. I wasn't sure if that applied since the right side was explored. The surgeon had coded both. Definitely thank you for the mod info, I did miss that. So I should question the two cpt codes billed?

Chronic does appear in the index. The main term for sinusitis includes the word chronic in parentheses.

You cannot bill those 2 CPT codes together. No modifier will override the NCCI edit.