AAPC - Back to school
Results 1 to 6 of 6

Thread: CPT code 31231

  1. #1

    Default CPT code 31231

    AAPC: Back to School
    I have a provider billing an endoscopy on every office patient even if it is a case of the sniffles. Is this appropriate? Would not a nasal speculum provide the same results? I can see if the condition were not to improve to do this procedure but every single time seems rather excessive.

    Please any advice from the ENT experts I would appreciate!
    Kelly Long CPC, CFE
    Manager Audit and Compliance

  2. #2

    Default Excessive.........

    I have worked for ENT for 18 years (12 physicians) and would say yes, nasal endoscopy for every patient is EXCESSIVE, but, on the other hand, as long as the documentation and clinical diagnosis can support the charge.........Have you had any problems with reimbursement? Do you have a good working relationship with this provider? that you might ask why they feel it is necessary for every patient to be scoped. Also, I strongly suggest you advise them that this sort of billing behavior might send up red flags and consequently result in audits and investigations into their billing practices.

    Good Luck...


  3. #3


    I am the auditing investigator.
    Kelly Long CPC, CFE
    Manager Audit and Compliance

  4. #4
    Join Date
    Apr 2007
    Madison Area Chapter in Madison WI


    Kelly, As a consultant, my first question for each record would be "Is this medical necessary?" If the scope is medical necessary, no problem, I'd say the service is billable.

    If the service isn't medical necessary, I would not support the billing of the scope.
    Happy Coding, Claudia

    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    ccrsconsulting.com - website

  5. #5

    Default Cpt 31231

    OK, my bad, I was intent on responding I was not paying attention to your credentials
    As Claudia and I both indicated, if the documentation and clinical diagnosis support medical necessity than the service is billable. BUT....and I say this with 18 years and 12 ENT physcians worth of experience, nasal endoscopy is done at the discretion of the physician when nasal speculum exam is not adequate and/or the patient has on ongoing situation and/or post-op care, etc... I am curious, does this physician have an operative note indicating pre/post-op diagnosis, intra-operative findings and indicate anesthesia, etc...for every patient they bill?

    I am inclined to agree with you that this type of billing is excessive...with 12 providers, I have not experienced this........Obviously you are auditing for a reason...

    Good Luck


  6. #6


    Thank you for the very helpful responses. I have completed my investigation and this particular provider failed to provide the documentation making this procedure medically necessary.

    Have a great weekend!!
    Kelly Long CPC, CFE
    Manager Audit and Compliance

Similar Threads

  1. 31231
    By casswhitehead in forum ENT/Otolaryngology
    Replies: 1
    Last Post: 11-14-2014, 02:03 PM
  2. Help with 31231
    By casswhitehead in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 11-14-2014, 12:53 PM
  3. 31231 help please
    By live&learn in forum ENT/Otolaryngology
    Replies: 3
    Last Post: 03-26-2014, 02:26 PM
  4. 31231 help
    By kerileigh in forum ENT/Otolaryngology
    Replies: 5
    Last Post: 02-17-2014, 07:13 AM
  5. EM with 25 and 31231
    By awillis52 in forum ENT/Otolaryngology
    Replies: 1
    Last Post: 12-15-2011, 12:51 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.