The ABCs of CPT Coding

Modifier 50: Indicates a similar procedure performed on both the left and right sides during the same surgical session. This is applicable to all endoscopic sinus coding except 31231 (nasal/sinus endoscopy, unilateral or bilateral).

Modifier 51: Indicates more than one surgical service performed by the same physician during the same surgical procedure. Identifies services subject to multiple procedure reductions.

Modifier 58: While not used as often in relation to endoscopic billing, this is applicable to secondary thyroid surgery for malignancy.

Modifier 59: Indicates a procedure or service not normally done together, or a separate incision, excision, or lesion. This code is increasingly being utilized.

Correct Coding Initiative, or CCI, edits are important in bundling and unbundling procedures. Some codes are components of others, said Dr. Jacobs. Don’t use multiple codes together in this case or you will not be paid for all services.

Modifier 79: This unrelated procedure modifier is important with debridement codes. If you append this unbundling modifier, it should allow bypassing or overriding of payer edits.

The code for FESS is usually delineated by side. To receive your full fees for secondary procedures, use modifiers 50, 51, and potentially 59.

Turbinate Issues

There are four major codes for this:

30801 – Cautery/ablation mucosa of turbinates, unilateral or bilateral, any method, separate procedure

30802 – Intramural

30130 – Excision turbinate, partial or complete, any method [resect mucosa]

30140 – Submucous resection turbinate, partial or complete, any method [preserve mucosa]

Carriers use software that automatically bundles these codes with FESS or septal surgery. Your claim may be denied based on same incision or gaining access.

Be very specific about the indicators, warned Dr. Jacobs. You must include all information in your post-op report. If you perform a nasal endoscopy, you must document the reasons. We even include a diagram with our post-op reports.

Comprehensive documentation is key for reimbursement on all coding submitted. In any instance, if your claim is denied, there are actions you can take. You can appeal a denial, said Dr. Setzen. Send a copy of the operative report to the insurance carrier. If you get no response, send it to the commissioner for insurance of your state.

©2006 The Triological Society