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Coding tip: Code the appropriate endoscopy of each anatomic site examined in the same session for ENT endoscopy procedures

Ambulatory Surgery Reimbursement Update, January 15, 2008

You often hear physicians refer to ear, nose, and throat (ENT) endoscopy procedures as Functional Endoscopic Sinus Surgery (FESS). Proper coding of these procedures can be tricky, so it is important for the surgeon to be precise and detailed in the operative report documentation.

The surgeon needs to identify the specific anatomic areas viewed by the endoscope during the surgery, and it is important that he or she detail how he or she accessed the sinuses during the surgery. It is equally important for the coder [for billing either on the facility side, or in the doctor's office] to read the entire operative report fully, and not code from the summary statements of the procedure at the beginning of the operative report.

When coding endoscopic ENT procedures, code the appropriate endoscopy of each anatomic site examined in the same session, and check Correct Coding Initiative (CCI) unbundling material carefully. Most of these procedures are not unbundled from one another.

Since the 31231 diagnostic endoscopy procedure is accessing only the nasal cavity, turbinates, inferior meatus, and the middle meatus areas, it is a less complicated procedure. The surface area covered is from the nostrils to the posterior edge of the soft palate. This procedure can be unilateral or bilateral. The CPT Manual designates this code as a separate procedure, and it is not billable when the physician performs other (more extensive) sinus procedures. Code 31237, "polypectomy," is also designated as a separate procedure, and is not billable when the physician performs other (more extensive) sinus procedures.

This tip is brought to you by Ellis Medical Consulting, Inc.

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