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Endoscopic sinus viewing

  1. #1
    Default Endoscopic sinus viewing
    Medical Coding Books
    Hi all~ My doctor performed 30520 septoplasty (90 day global), 31255 & 31267 (no global) for sinuses. Patient comes in this month and this is the exam:

    VITAL SIGNS

    Height: 63 in.
    Tobacco Use: never
    Allergies reviewed - no changes
    OFFICE NOTE

    CHIEF COMPLAINT: Patient returns to the office today in follow up, status post nasal septoplasty, bilateral total ethmoidectomies and left maxillary sinusotomy with tissue removal.

    HISTORY OF PRESENT ILLNESS: Patient reports ongoing "sinus headaches." She denies any purulent rhinorrhea or fevers. She does remind me that she has multiple types of headaches, including migraines, etc.

    She indicates that she is irrigating 2-3 times per day.

    PHYSICAL EXAMINATION: Anterior rhinoscopy reveals clear nose and midline septum.

    The patient's sinuses were examined endoscopically. Both ethmoid sinuses bilaterally as well as the left maxillary sinus. The patient's sinus surgery defects are healing nicely. There is no evidence of any infection, bleeding, etc.

    IMPRESSION:
    1) Satisfactory postoperative course.

    RECOMMENDATIONS:
    1) Patient will continue to irrigate at least two times per day. We have asked her to return to see us on the three-month anniversary to surgery, some time in late July.

    PROCEDURE NOTE

    PROCEDURE: Nasal/sinus endoscopy; bilateral ethmoid and left maxillary sinus endoscopy.


    SURGEON:

    ANESTHESIA: Topical Lidocaine.

    COMPLICATIONS: None.

    ESTIMATED BLOOD LOSS: Zero.

    FINDINGS: Included .

    PROCEDURE: Following adequate Lidocaine spray analgesia, the patient's nasal cavities bilaterally, as well as ethmoid cavities bilaterally and left maxillary sinus carefully inspected using the fiberoptic endoscope. The above findings were noted.

    Patient tolerated the procedure well. There were no complications.

    I thought we should only bill 31233-79-50 and link sinus dx and 99024 and link dx for septoplasty because there is a component of E/M factored in to the 31233 code.
    He says that his academy fought for the codes 31255 & 31267 to not have a global and this essentially leaves him as having a global period because he can't bill a 992_ _-24 on this visit. I feel the documentation does not support a separate & identifiable E/M service.
    What do you think? All help is appreciated, Thanks!
    Last edited by beck627; 07-10-2008 at 03:32 PM. Reason: Miss typed code as 31255 instead of 31233

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Question
    Unless I missed something in the note, it sounds like post-op care so how is mod -79 justified?

  3. Default
    In his impression, the provider states "satisfactory post operative course". To me, this would signal a global service.

    ~L
    CPC, CGSC, COSC

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    If I read it correctly, there was a procedure performed in the office...which would justify the need for the modifier on the procedure code. I would use 78 instead of 79 though.

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    it appears to me, to be a postop follow-up - period, no office charge. in my opinion it should be modifier .58 on the procedure.
    Donna, CPC, CPC-H

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Red face
    Ok - I have re-read the original post and am re-thinking this situation. Because 31255 and 31267 do not have global days but 30520 does, it kind of makes this a difficult scenario. So you have a post-op visit for 30520 and you have the endoscopy 31233-50. I think the problem is getting the endoscopy past the global of 30520... It looks like the only thing you can do is use modifier -79 as unrelated to the septoplasty, since that is the only code from the original 3 procedures that has a global attached to it. I don't think you can bill an office visit though if the endoscopy was planned. Does that make any sense?

  7. #7
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Very well put Lisa, I agree

  8. #8
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    so, the endoscopy was done as a follow up to two procedures that don't have a global (31255/31267)? it wasn't done as part of the followup for the septo (30520) AND the other procedures?

    and yes, what Lisa says makes great sense - but, still - the endo wasn't done as follow up to "all" the procedures the patient had done?
    Donna, CPC, CPC-H

  9. #9
    Location
    Stuart Sailfish Chapter
    Posts
    867
    Default
    Hello all, our practice physicians perform 31233 and or 31237 as follow up after a FESS. 31256-31267 and 30520. you need to link the dx code of 473.XX to the 31233 or 31237 with mod -79.

    this is stated on the AAOHNS website. He gets credit for the procedure but NOT the E/M as well
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    Director of Operations
    Ear, Nose and Throat Associates of South Florida, PA
    772-342-6976
    cfenildo@entsf.com


    "Nothing is stronger than the heart of a volunteer"

  10. #10
    Default
    Wow! I am so happy so many of you responded to this. Thank you so much for lending your expertise. It is very much appreciated!

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