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Otolaryngology Coding Alert

READER QUESTION ~ Learn Exception to Indented Code Rule

Question: Should we assign 31254 and 31255 for an anterior ethmoidectomy?

Florida Subscriber Answer: You should not use 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) in addition to 31255 (- with ethmoidectomy, total [anterior and posterior]). Code 31255 is indented under 31254. Based on CPT Codebook instructions, the indent is a space saver. -- some of the procedures in the CPT codebook are not printed in their entirety but refer back to a common portion of the procedure listed in a preceding entry,- states CPT's -Format of the Terminology- notes. The common part of 31254 (the part before the semicolon) should be considered part of code 31255 -- a partial ethmoidectomy is considered part of a total ethmoidectomy. Therefore, coding both together for a same-side anterior ethmoidectomy is inappropriate.

To choose the correct anterior ethmoidectomy code, identify the extent of the procedure and use the most appropriate, specific code for the procedure. For instance, you should report an anterior and posterior ethmoidectomy as 31255 and an anterior with 31254.

Exception: If the otolaryngologist performs a partial ethmoidectomy and a total ethmoidectomy on separate sites, you should code both functional endoscopic sinus surgeries (FESS). To indicate that circumstances -- separate sites -- warrant separate payment for the partial ethmoidectomy, use modifier 59 (Distinct procedural service) on 31254. The modifier tells the payer that although 31254 is normally bundled to 31255, circumstances make reporting both appropriate.

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