Are you banking on 31575 for each of your diagnostic scope claim? You might be denying your practice up to $80 per claim, and in these times, you can’t manage to miss a dime. In case you can spot these significant terms for 31231 or 92511, then you can improve your claim’s bottom line. Read this expert medical coding article and know what ICD-9 and CPT codes apply.
You must grasp these scope fundamentals to ensure error-free claims.
ICD-9 and CPT Tip: Dismiss 92511 ‘Loser’ Myth
In case you’re like many ENT coders, you may not want to code 92511 (Nasopharyngoscopy with endoscope [separate procedure]) as you think it pays the minimum of the flexible scope codes. In reality, the code’s total value is in between the lower-paying 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) and the higher-paying 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]).
With the current Medicare Physician Fee Schedule’s conversion factor of 34.0376, the codes’ relative value units and payments in ascending order include:
Surprise: Even though 92511 pays $27.57 more than 31575, and 31231 pays $79.99 more than the laryngoscopy code, the Correct Coding Initiative takes 31575 as the all-inclusive code. Code 31575 includes 92511 as well as 31231.
Check for 31575 Medical Necessity
Trace how far a flexible scope goes to see in case you’re in 31231, 92511 or 31575 territory. You must use 31231 for a scope of the nasal cavity and sinuses. 92511 denotes viewing the nasal cavity down the throat until the nasopharynx (the edge of the soft palate). Code 31575 is for a medically necessary scope that observes all the way down to the larynx.
Example: An ENT used topical lidocaine for anesthesia and executed flexible fiberoptic laryngoscopy through the right nostril. The procedure note specifies, "The nasopharynx, vallecula, epiglottis, sinuses as well as vocal cords were all visualized."
As the scope goes all the way into the larynx, 31575 might be accurate based on anatomy. You must use 31575 instead of 92511 only in case the note shows that scrutinizing this far was medically necessary. There has to be a main complaint and a history of a problem demanding viewing all the way down to the larynx.
In case, however, the ENT is simply looking for the condition of the nasopharynx, like for eustachian tube dysfunction (the eustachian tube terminate in the nasopharynx) or a mass in the nasopharynx, you would code 92511.
ICD-9 and CPT Expert Advice: Should You Make This ‘Rigid’ or ‘Flexible’ Distinction?
Even though you may think 31525 is meant for rigid laryngoscope and 31575 is for flexible laryngoscope -- end of story -- you need to keep in mind that the nasal exam (31231) may include a rigid scope. Consequently, you cannot assume a rigid scope is a laryngoscopy carried out under sedation.
ICD-9 and CPT Hint: ENTs do not execute rigid laryngoscopies in the office. Providers will schedule them for the OR on an outpatient basis. Thus, when the service is an office diagnostic procedure, a rigid scope simply means you should report a 31231.
