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Click here for more sample CPC practice exam questions and answers with full rationale

Nasal Conformers/Nostril Sizers/Plastic Tubes

Need help with something new we are seeing in the hospital setting. After a cleft lip/palate repair the patients are coming to the hospital, because of their age, to have the nostril sizers/stents or tubes upsized. Is there a code for this procedure? We have been using CPT code 30999. Don’t like 31299 because that involves the sinus and 30220 is for a septal prosthesis. " Old stents were removed and the nostril sizers were used to decide the adequate size that would provide maximal support. The #7 sizer was a fit and place in and a suture was placed to anchor it in place". Any help is appreciated. Thanks Buttercup

Medical Billing and Coding Forum

Help with which code to bill for nasal scope

I have recently took over billing at the Dr. office I work for. We do nasal scopes with a flex scope. We mainly do the scopes to check the sinus area out but he will go and see the larynx as well. Do I code a 92511 for nasopharyngoscopy, or 31231 for nasal endoscope, or 31575 laryngoscopy? I am confused on this one. I know reimbursement is higher for nasal enoscopy. I also know the purpose of the procedure is to make sure sinus is draining properly and no issues in any of the sinus area.

Thank you

Medical Billing and Coding Forum

nasal packing

We are having a discussion as to how to code a procedure. Had a patient come in with nose bleed, provider states in documentation that he saturated 2×2 gauzes with Afrin spray a clamp was used to apply pressure with no active hemorrhaging. Nasal packing performed with tampon, hemorrhaging was controlled.The provider is saying that code 30903. Not sure I agree as coders desk reference gives a description of "uses extensive coagulation or extensive packing."

Please help.

Paula

Medical Billing and Coding Forum

Flu Nasal Swab Test Billing

Hello! We’ve recently purchased the nasal swab rapid flu test that tests for both Influenza A and Influenza B. (One swab; two results)
I’ve done some research and wanted to make sure I am going to be billing correctly. I read that we should bill the procedure (87804) two times since the test gives two results and to use modifier 59 on the second test. Also, I read to use modifier QW since this is a CLIA waived test. Does it matter which modifier to use first? Also, do I need to use the QW modifier on both lines? THANKS, in advance!! 😀

Medical Billing and Coding Forum

Endoscopic nasal foreign body removal

Hi all,

I’m unsure as to what to code for this report:

"After informed consent was obtained, the patient was brought to the operating room and placed supine on the operating table. General anesthesia was administered by the anesthesiologist. After a time out was performed and the patient was properly identified, the bed was rotated.

The nasal endoscope was placed in the right nares with no purulence or edema present. The nasal endoscope was placed in the left nares with copious purulence which was cultured. The purulence was suctioned and a foriegn body was identified. The foreign body was grasped with a blakesly forcep and removed. It appeared to be rolled up gauze or tissue. The nasal cavity was exmined with granulation tissue along the septum, nasal floor and inferior turbinate. The cavity was irrigated with nasal saline until clean. Hemostasis was checked with minimal bleeding from the granulation tissue. The adenoids were examine and found to be nonobstructive without exudates so no adenoidectomy was performed. Two afrin pledgets were placed until extubation.

The patient was turned over to anesthesia for extubation. The nasal pledgets were removed once the patient was extubated. He was brought to the recovery room in stable condition."

Please note that the scope was in the nose while the foreign body was removed. I’m confused if 30999 with comparative code 30310 should be billed or both 31231 & 30310.

Your assistance will be greatly appreciated!

Medical Billing and Coding Forum

nasal endoscopy with cautery(silver nitrate)

Hi. I’ve read the many other threads on this subject and still need some help.
Pediatric pt brought into DSG for:

Pre and Post Op Dx: Recurrent Epistaxis
Px: Nasal Endoscopy with Cautery

Description:
‘… The nasal passages were examined with a 0-deg endoscope. There were no masses or lesions noticed on either side as far distal as the adenoid pad. There were enlarged vessels anteriorly on both sides of the septum. These vessels were cauterized with topical silver nitrate. Bacitracin was applied to cauterized areas. This concluded surgery. …’

I coded 31238-50-endoscopy with control of nasal hemorrhage. An Auditor is recommending 31299- unlisted, Because there is no active bleeding stated.

Does the 31238 require the bleeding to be current? Or does the simple fact that the pt has had multiple nose bleeds in the past account for the need for surgery.

Other coding suggestions? 31231 with 17250?

Thanks for the help,
Gina

Medical Billing and Coding Forum

J34.0 for abscess of nasal sidewall?

Our EMR is coding abscess of the nasal sidwall as J34.0 (Abscess, furuncle and carbuncle of nose). Since this code falls under "Other diseases of upper respiratory tract." I would think that it should be used for lesions inside the nose (since the skin of the outside of the nose is not part of the respiratory tract) and would use L02.01 (cutaneous abscess of face).

Which is correct?

Medical Billing and Coding Forum