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Debridement for 30520 with 31276

Norelie Posted Wed 12th of December, 2012 17:32:16 PM

Can I bill office visit with dx of 473.8 (-24,-25 mod) and 31237
(-79)debridement with dx 473.8 if this is still in global period for septoplasty?

SuperCoder Answered Thu 13th of December, 2012 20:26:47 PM

This will depend. Please consider the scenario:

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 to the postoperative period. Modifier 79 can save you from appeals hassles. The documentation must demonstrate that the debridement is unrelated to the septum and/or turbinates and related only to the sinuses.

Also, remember 31237, unlike 31231, is a unilateral code, so you should bill 31237 or 31237-50, depending on whether the surgery was unilateral or bilateral.

Related: But if the debridement is related to the septoplasty/turbinectomy, you should include the related care in the surgery package. For instance, do not bill 31237 for postoperative septo or turbinates, even though the turbinates may require debridement at times. The ENT has already been paid for the post-op visits related to the septo and/or turb procedures because 30520 and/or 30130-30140’s surgical fees include debridements.

Documentation should reflect that the debridement is unrelated to the reason that the otolaryngologist worked on the septum and or turbinates, and it should show medical necessity for the debridement.

Example: After a septoplasty for a deviated septum, a turbinectomy for hypertrophy, a total ethmoidectomy for ethmoidal sinusitis (473.2) and a maxillectomy for maxillary sinusitis (473.0), an otolaryngologist performs debridement. Documentation indicates the debridement was to remove the crusting that occurs following sinus surgery, to prevent infection and to keep the airway patent.

Because the ENT performs the debridement for a reason (chronic ethmoidal and maxillary sinusitis) that is unrelated to the reason for the septoplasty and/or turbinectomy, you should report the debridement.

Append modifier 79 to 31237, and include a note that “the debridement is unrelated to procedures 30520 and/or 30130-30140, diagnosis 470 (Deviated nasal septum) and 478.0 (Hypertrophy of nasal turbinates) on date of surgery xx/xx/xxxx.” The diagnosis you should use with the unrelated sinus debridement must be the chronic sinus disease, 473.0 and 473.2.

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