coding Functionnal endoscopic sinus surgery and septoplasty

Hi,
I am an ENT surgeon performing a large number of FESS/Septoplasty,
We have been experiencing problems with reimbursement:bundled cpt, not paying for 30520, etc...
These are bilateral procedures and multiple procedures as well:30520, 31255, 31267, 31276, 31288, etc...
Could you please tell us, what would be the optimal way for coding and particularly advise on the best use of modifier-knowing that 30520 is often not paid.
Also, please advise about different requirements per carriewrs for reporting those claims.
Thank you very much for your kind attention,
Jean-Michael Hasson, MD

Fess

A lower-paying bilateral procedure might trump a higher-paying procedure. For instance, if you performs unilateral FESS (31254-31288) with septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft), the septoplasty is higher. But if you performs bilateral FESS, that procedure is valued higher than the septoplasty.

If you’ve been using modifier 50 (Bilateral procedure), look at your payments to see if the insurer has been paying you unilaterally (at 100 percent) instead of bilaterally (at 150 percent). Audits frequently reveal documentation and coding that supports a bilateral procedure that the insurer has paid unilaterally.

The insurer may incorrectly process Medicare’s preferred modifier 50 method of a one-line entry with modifier 50 (such as 31254-50). Private payers may want bilateral procedures on either two lines with modifier 50 on the second line (31254, 31254-50) or no modifier with two units on a single line item (31254 x 2).

Coding FESS/Septoplasty

If you are linking the diagnosis of deviated nasal septum to the septoplasty, and using appropriate modifier (51 if necessary) you should not have a problem with reimbursement. I'm curious to know how it's being billed and exact denial codes.