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Thread: Desperatly need ENT coding help

  1. #1

    Default Desperatly need ENT coding help

    AAPC: Back to School
    I am uncertain whether I have coded this correctly--the more I think about it, he more confused I get--know whatI I mean? :-)

    I have very little experience with ENt and realy need some help! Here is the case scenario: (a) Left frontal sinus endoscopy incl exploration & removal of diseased tissue; (b) Bilateral anterior & posterior ethmoidectomy; (c) Bilateral maxillary antrostomy; ALL same session in an outpatient hospital surgery setting.

    I chose CPT's 31255-50; 31256-50 and 31276

    I chose ICD-9 Volume 3 procedure codes 22.63; 22.2 and 22.42

    Is this right? PLEASE advise!

    Also do iI use Modifier "51" on the codes also? Which ones?

    Any modifiers on the Volume 3 codes?

    Thanks sooo much!


  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    I did not look up your codes but if this is outpatient then you do not code the Volume 3 codes at all. Not for the facility claim or the physician claim. The 51 modifier is not used in the facility at all and for the physician is required by only a few payers so you would need to know. And again modifiers are not used on Volume 3 codes ever. You sould also check for bundleing in senario. It would help to have the procedure note to be able to check your codes and dertemine if other modifiers are necessary.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Default Urgent: STILL Need ENT Answer!


    OK--first, the setting is outpatient surgery in the HOSPITAL; in this scenario when billing for BOTH physician AND facility, I just use CPT codes? Is that what you're saying?

    Second the note just states: "left frontal sinus endoscopy, exploration & removal of diseased tissue" (just like CPT code 31276 states); "bilateral anterior & posterior ethmoidectomy" (just like CPT code 31255 states); and "bilateral maxillary antrostomy" (just like CPT code 31256 states)

    This payer DOES require the "51" if it is aplicable! Sooo...I need to know if it is correctly applied for the physician portion?

    FINALLY...for my info...if the Volume 3 codes never get modifiers applied, first how does one indicate bilateral & multiple procedures? second what are the "hospital approved modifiers" for? Now I'm totally confused!

    Thanks SO Much!


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