Health Information Management

Q&A: Coding incidental services for outpatient procedures

JustCoding News: Outpatient, October 7, 2009

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QUESTION: We work for an allergy, ear, nose, and throat clinic. One of our patients was seen in the hospital as an outpatient for a nasal/sinus biopsy endoscopy, surgical; with biopsy polypectomy or debridement (CPT code 31237). The patient also underwent a nasal/sinus endoscopy, surgical; with control of nasal hemorrhage (CPT code 31238).

We reported CPT codes 31237 and 31238; however, the payer stated that CPT code 31237 is incidental to CPT code 31238. Should we report different codes or append modifier -59 to CPT code 31238?

ANSWER: The term ‘incidental’ tells us that the third-party payer believes that the biopsy is included in the process of controlling the nasal hemorrhage and that you should not code it separately. You may find further guidance in the May 2003 issue of CPT Assistant.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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