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Otolaryngology Coding Alert

Ask 2 Questions Before Coding Debridement -- or Pay the Price

You can report 31237 as a post-op procedure If denials and quickly advised -don-ts- are making you reluctant to code for postoperative endoscopic debridement, gain the confidence to use 31237 by pinpointing the initial surgery and the postprocedure's reason. Which Surgery Did the ENT Initially Perform? An otolaryngologist may perform postoperative debridements (31237, Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]) for sinusitis after functional endoscopic sinus surgery (FESS, 31254-31294), which may also include septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and/or turbinectomy (30130, Excision inferior turbinate, partial or complete, any method, or 30140, Submucous resection inferior turbinate, partial or complete, any method). Before you can determine if you should report the debridement, you must identify the primary surgery. Why: The Medicare Physician Fee Schedule assigns different global periods to 30520, 30130-30140 and FESS codes. Codes 30520 and 30130-30140 have 90-day global periods. But FESS codes contain zero global days. Different global periods equate to two coding scenarios. Scenario 1: The otolaryngologist performs debridement after sinus surgery. Because FESS codes have zero global days, you can bill the debridement after endoscopic sinus surgery with 31237, says James A. Stankiewicz, MD, with Loyola University Medical Center, department of otolaryngology, in Maywood, Ill. -The chart needs to have appropriate documentation that endoscopic debridement was performed and was the focus of the visit,- according to Stankiewicz's article -Management After Sinus Surgery- in the American Rhinologic Society's (ARS) July 1999 newsletter. Tip: Challenge payers that allege to follow Medicare's resource-based relative value scale but bundle the debridement as included in an insurer-created FESS package. CMS -assigned payment values for FESS assuming that medically necessary subsequent diagnostic endoscopies (CPT code 31231) or surgical endoscopies with debridement (CPT code 31237) would be reimbursed separately as outside the zero-day global period,- writes Joseph B. Jacobs, MD, New York University Medical Center in New York City in a March 2000 ARS Socioeconomic Update. Scenario 2: But when your otolaryngologist performs a debridement within 90 days after septoplasty and/or turbinectomy with or without FESS, the debridement falls within 30520's and/or 30130-30140's global surgical periods. Billing the debridement hinges on the answer to another question.
Why Did the ENT Perform Debridement? Next, you need to focus on what the physician is debriding and why after performing a septoplasty and/or turbinectomy with or without FESS. Unrelated to septo/turb: When the otolaryngologist performs debridement for a reason that is unrelated to why she worked on the septum and/or turbinates, you should bill for the debridement. Append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 31237 to indicate that the debridement is unrelated [...]

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