New, revised and deleted codes come into effect each year on January 1. Outsourcing companies providing billing and medical coding services review the updates carefully to ensure that the physician practices they serve make the necessary changes to their resources and protocols for accurate claim submission.

In Calendar Year 2020, otolaryngology practices are dealing with important changes to endoscopic sinus billing and coding, which include changes to CPT code descriptors and application of the special rule for multiple endoscopic procedures.

About Nasal Endoscopy

Nasal endoscopy is a common procedure performed in the otolaryngologist’s office. It involves using an endoscope to view the nasal and sinus passages. A nasal endoscope consists of a thin, flexible tube with a tiny video camera and a light. The instrument projects magnified images onto a screen. The minimally-invasive nasal endoscopy procedure helps in the diagnosis and treatment of the following health conditions:

  • Nasal congestion
  • Nasal blockage
  • Nasal and sinus infection (rhinosinusitis)
  • Nasal polyps
  • Nasal tumors
  • Nosebleeds
  • Loss of ability to smell
  • Cerebrospinal fluid leak

Nasal endoscopy allows the physician to obtain details about problems, such as bleeding and swelling of the nasal tissues or a growth, which direct visualization cannot provide. It can be used to remove a foreign object from the nose or to assess the progress of treatments for sinus and nasal problems.

If there is a blockage, sinus surgery can remove the obstruction, open the sinuses, and restore natural drainage. Endoscopic sinus surgery is clinically indicated for patients with chronic sinusitis, or other conditions, such as nasal tumors and nasal polyps. In some cases, small instruments may be used to remove tiny samples of tissue or perform other tasks.

Nasal Endoscopy Billing and Coding Changes

  • Revised nasal/sinus endoscopy CPT code descriptors: The descriptors of several nasal/sinus endoscopy codes have been revised for 2020. The codes are now arranged into more specific families (www.medtronsoftware.com):
    • 31292 Nasal/sinus endoscopy, surgical, with orbital decompression; medial or inferior wall (Do not report 31292 in conjuction with 31237, 31253, 31254, 31255, 31257, 31259, 31293, 31296, when performed on the ipsilateral side)
    • 31293 Nasal/sinus endoscopy, surgical, with orbital decompression; medial and inferior wall (Do not report 31293 in conjuction with 31237, 31253, 31254, 31255, 31257, 31259, 31292, when performed on the ipsilateral side)
    • 31295 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa (Do not report 31295 in conjuction with 31233, 31256, 31267, when performed on the ipsilateral side)
    • 31296 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium (Do not report 31296 in conjunction with 31253, 31276, 31297, 31298, when performed on the ipsilateral side)
    • 31297 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium (Do not report 31297 in conjunction with 31235, 31257, 31259, 31287, 31288, 31296, 31298, when performed on the ipsilateral side)
    • 31298 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostia (Do not report 31298 in conjunction with 31235, 31253, 31257, 31259, 31276, 31287, 31288, 31296, 31297, when performed on the ipsilateral side)
    • There is also a new Category III code: 0583T Tympanostomy (requiring insertion of ventilating tube), using an automated tube delivery system, iontophoresis local anesthesia
  • Special rules for multiple endoscopic procedures: CMS has made the special rule for multiple endoscopic procedures applicable for procedures represented by nasal sinus medical codes 31231-31298.
  • The key points to note are as follows:

    • CPT 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure), is the base code for this family of endoscopic surgeries. This base code is considered integral to the other endoscopic sinus surgeries. It is never paid separately when performed with other endoscopic services in the family.
    • Code 31231 is cannot be reported with more extensive nasal endoscopies unless the more extensive nasal endoscopies are performed on different sites/structures/locations. Modifier 59 or modifier XS would still be used with 31231 under the multiple endoscopy rules.
    • If two or more sinus endoscopies in the same family are performed that do not include the base code 31231, each may be reported.
    • In 2018, four new Nasal Sinus Endoscopy codes (31241, 31253, 31257, 31259, and 31298) were introduced. Each code describes bundles of services frequently performed together. AAPC cautions: “The multiple endoscopy rule does not give license to unbundle these scope codes.”

    With the multiple scope rule, otolaryngologists will get be reimbursed 100 percent for the highest valued procedure. The other nasal endoscopy codes will be paid at their value minus the value of the base code, 31231.

  • Billing bilateral procedures: In response to a commentator request, CMS also clarified that a multiple nasal endoscopy procedure that is performed bilaterally will be multiplied by 150 percent and then the fee for the base nasal procedure, 31231, will be subtracted (www.aapc.com).

Proper Documentation is Critical to Prevent Claim Denials

A special study of Medicare Part B claims for diagnostic nasal endoscopy submitted between April and June 2014 found that insufficient documentation was the most common reason for most improper payments, according to an AAPC article. To reduce risks of denial, providers must meet the documentation requirements of Medicare administrative contractors.

Four essential elements that must be documented in the medical record are:

  • The correct date of service
  • The reason for the procedure
  • The results of the procedure
  • The physician or other qualified healthcare professional’s signature (and/or signature log, or attestation)

With accurate and complete clinical documentation, medical billing and coding companies can connect services provided with the right nasal endoscopy billing codes for appropriate reimbursement.