Accurate Sphenopalatine Artery Ligation Coding

Make the maximum of surgical procedure modifiers when looking for the correct code.

Where conservative treatment is unsuccessful, endoscopic transnasal tactic for ligation of the sphenopalatine artery might be the best surgical technique for control of a severe epistaxis. But did you know that there are no medical CPT codes that exist precisely for this operative procedure? Read this article for expert insight on accurate medical coding.

Let's assume a scenario where a patient with coagulopathy also has epistaxis which has not been controlled with nasal packing. The bleeding starts from the posterior nasal cavity of the posterior ethmoid artery or a branch of the sphenopalatine artery. In order to gain control over the nose bleed, the otolaryngologist chooses to conduct an endoscopic transnasal sphenopalatine artery ligation.

When you're left without a certain CPT® code to label the procedure, you should go for other similar medical CPT codes, and try to work around it. Let's explore your options with the following medical CPT codes.

31238: Improve Endoscopic Control of Nasal Hemorrhage With Modifier 22

Medical CPT® 2011 guidelines for modifier 22 maintain that when the work needed to provide a service is significantly greater than typically needed, it may be recognized by the addition of modifier 22 to the typical procedure code.

Documentation should support the substantial added work and the reason for the added work.

In case of an endoscopic transnasal sphenopalatine artery ligation, you might report 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) appended by modifier 22 (Increased procedural service). This particluare ligation procedure includes interrupting the nasal vasculature at a place distal enough to avoid direct, retrograde, and anastomotic blood move from the ipsilateral and contralateral carotid systems.

Disadvantage: Though 31238-22 is a practical and correct medical coding option, payer reimbursement may be lesser than what surgeons feel is regular with the related physician work: about $200.46 (5.9 facility RVU, multiplied by the 2011 conversion factor of 33.9764).

Remember: 31238 a surgical endoscopy code. Ensure that you pay close attention to how the operative note (OR) explains the endoscopic use.

31299: Go The Safe Way With Unlisted Medical CPT Codes

You may also choose to use unlisted procedure code 31299 (Unlisted procedure, accessory sinuses). Several coders would in fact commend this option; however you must be careful of the hitches:

A lot of the claims don't get paid the first time they are submitted and processed. They need appeal with documentation describing what was done.

Documentation necessities (paperwork) may prove to be demanding.

Some experts endorse to use an unlisted code when conducting a procedure that has a medical CPT code meant for an open method however does not have a CPT code for an endoscopic approach.