Question:

Can a biopsy code (i.e., CPT® code 31237 for nasal/sinus endoscopy) be reported with the removal nasal/sinus endoscopy code (i.e., CPT code 31255)?

Answer:

According to the NCCI Manual, if a patient presents with nasal obstruction, sinus obstruction and multiple nasal polyps, it may be reasonable to perform a biopsy prior to, or in conjunction with, polypectomy and ethmoidectomy. A biopsy performed in conjunction with a more extensive nasal/sinus procedure is not separately reportable unless the biopsy is examined pathologically prior to the more extensive procedure, and the decision to proceed with the more extensive procedure is based on the result of the pathologic examination.

Therefore, state the Centers for Medicare & Medicaid Services (CMS), the two codes listed below should not be reported together because the biopsy tissue is procured as part of the surgery, not to establish the need for surgery.

31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)
31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)

 


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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.