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Nasal endoscope w/ debridement

Dbedard

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Does anyone know if debridement with frazier tip suction of post operative drainage via nasal endoscope actually counts as debridement? Coder Desk Reference says scapels, forceps, snares and the other instruments are used for 31237 but I am unsure if this counts. I appreciate your input. Thanks
 

hart65ley

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Jacksonville/Jacksonville Beach
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bumping for a response on this, please.

And I'd like to add a question as well. Office notes for post operative revision FESS reads:

"osteomeatal complexes clear but has extensive mucosal swelling. no purulence and usual post operative packing and dried blood and crusts-removed. Middle turbinates: normal. Secretions: clear rhinorrhea. Topical Anesth/Scope: decongestants, w/ lidocaine 4%, bilateral, 0 degree 4mm scope, #7 Fraizer suction."

If there is normal/usual post operative crusting (or light/minimal crusting), is 31237 still billable?

Thanks
 
Last edited:

jackjones62

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259
Location
Niantic, CT
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It has always been my position that there are a lot of gray areas in coding and that you need to make decisions using your best judgement and be able to argue your choice of codes, this means making sure you have the medical documentation to back you up.

I have had many conversations with my doctors regarding documentation concerning post-op debridements, CPT 31237, it is a procedure and therefore there should be an operative report indicating type of anesthesia used, instrumentation and procedure itself; some of my doctors write it in the body of notes, some dictate an actual operative report and some use a templated operative report and fill in the blanks, but the documentation must be there.

With regards to CPT 31237 and using suction for debridement, my personal opinion is that it constitutes as "other equipment"; this CPT code covers a lot of ground, eg, biopsy, polypectomy and/or debridedment, so there is a lot of different type of "instrumentation used; therefore, I feel confident in the way I choose to use this code; as far as light/minimal crusting removed, again, that is your judgement call; you need to discuss with your doctor if you are not comfortable in charging 31237 and may consider just charging nasal endoscopy, CPT 31231.

I hope this helps.

Jennifer
CT ENT
 
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