Watch Out For These Endoscopy Bundles

Published: 19th June 2010
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Code 31575 covers 92511 and 31231 except under these conditions

Singling out the right endoscopy code when your otolaryngologist tests multiple areas in the sinuses and throat is not always an easy bet; however in most cases it is very important to settle on one, according to National Correct Coding Initiative (NCCI) edits. You can stick to these edits and avoid payback requests if you stick to these guidelines.

Three rules show you the way

Rule #1: Never go for 92511 (Nasopharyngoscopy with endoscope[separate procedure]) and 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) in unison.

Rule #2: Code 92511 is a component of Column 1 code 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) however a modifier is allowed to differentiate between the services provided (i;e, you may go for modifier 59 (Distinct procedural services) if there're separate and identifiable services with separate medical indications). Go for 92511 in sync with 31575 for the same encounter, Levinson says, only if the ensuing conditions are met:

  • There are different medical indications for examining each area ( for example, 784.49 for hoarseness with 31575 in an adult patient with a hyperactive gag reflex and 381.4 for a unilateral or bilateral middle ear effusion with 92511, which would be a rare occurrence), and

  • The ENT makes use of different scope for each, separate procedure as there's a documented reason that the fiberoptic scope didn't provide sufficient visualization of the nasopharynx. Levinson emphasizes, "This would be highly unlikely."

    Rule #3: Code 31231 is a part of Column 1 code 31575; however a modifier is allowed in order to distinguish between the services provided. The need to coreport these services for the same encounter, however would also take place quite infrequently. The mixture of 31575 with 31231 would likewise call for separate endoscopes, Levinson says.

    Think prior to appending modifier 59

    Some medical coders incorrectly think that appending 59 to an endoscopy bundle will result in double payment when the ENT visualizes more than one area. However, appending 59 is wrong in most instances.

    When CCI created the endoscopy bundles, it realized that the bundled codes described different sites, says Barbara J. Cobuzzi, MBA, CPC, CPCH, CPC-P, CENTC, CHCC, president of N.J.-based CRN Healthcare Solutions. As such, attempting to break the endoscopy bundle based on the ENT examining two different sites is apt.

    Exception: If the ENT carried out the two endoscopies at two different encounters on the same day for two distinct medical reasons, you'd be safe in using modifier 59, says Cobuzzi. This scenario would not be uncommon.

    Here's an example: If the ENT carried out a laryngoscopy (31575) in the office in the morning for postnasal drip (784.91), and in the morning for postnasal drip (784.91), and in the afternoon she carried out a nasal endoscopy (31231) for unrelated epistaxis (784.7), you may use 59 to the column 2 code 31231.

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