Wiki modifier 52 with 31231

[wynonna]

Hello:
So how does modifier 52 affect payment for a nasal endoscopy done in the office?
Or is it informational only?
thank you

 

[sls314]

Hello:
So how does modifier 52 affect payment for a nasal endoscopy done in the office?
Or is it informational only?
thank you

Medicare reduces payment by 50% for modifier 52.

https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144533

Commercial insurance will likely do the same, unless the provider's contract specifies something different.

 

[wynonna]

thank you Susan:

"Findings :

Superior meatuses: Clear
Middle meatuses: Clear, no pus or polyps
Sphenoethmoid recesses: Clear

Nasopharynx and endolarynx are normal"

Would this be adequate documentation for 31231? done in Outpatient, office setting

 

[sls314]

thank you Susan:

"Findings :

Superior meatuses: Clear
Middle meatuses: Clear, no pus or polyps
Sphenoethmoid recesses: Clear

Nasopharynx and endolarynx are normal"

Would this be adequate documentation for 31231? done in Outpatient, office setting

Is there something stating the procedure performed? These are just the findings - is there more in the note saying that an endoscopy was performed?

I'm not an ENT coder, so this isn't my exact area of expertise. However, my oncologists do perform flexible laryngoscopy (31575) in office, and their notes include specific detail about the scope, the local/topical anesthesia used, etc. I would expect that documentation for a 31231 should include that level of detail as well.