Wiki Nasal endoscopy

[coderguy1939]

On op report in list of procedures, the doctor indicates bilateral nasal endoscopy with ethomoidectomies. In the Procedure in Detail he just states that a microdebrider was used to perform ethmoidectomies but does not indicate that he used the endoscope. Does use of a microdebrider support coding endoscopy or does the doctor have to state that endoscope was inserted? Thanks for your responses.

 

[Candice_Fenildo]

he should really dictate that the endoscope was used. Remember, if it's not documented it wasn't done

 

[coderguy1939]

THank you for your reply. I appreciate the input.

 

[jackjones62]

HELLO.........bilateral endoscopy with ethmoidectomies!!!!!, did the physician mention 0 degree scope or anything of that nature in the body of the note??? if they did not, it is up to you to communicate with the physcian with regards to their dictation habits and what was actually done; ask them to amend their op reports to support the claim, especially when you are certain it was done endoscopically; do not settle for a lesser reimbursement due to this type of situation, correct it, help your physician maintain a financially viable practice.

Jennifer
ENT CT