Endoscopic transnasal approach for ligation of the sphenopalatine artery may be the surgical technique of choice for control of a severe epistaxis when traditional treatment has met with failure. But the fact is there's no CPT code for this operative procedure.
Let us say a patient with coagulopathy has epistaxis which hasn't been controlled with nasal packing. The bleeding takes form from the posterior nasal cavity of the posterior ethmoid artery or a branch of the sphenopalatine artery. In order to put a check on the nose bleed, the otolaryngologist decides to carry out an endoscopic transnasal sphenopalatine artery ligation.
When you are left with a definitive CPT code to describe the procedure, you should look at other similar CPT codes, and try to work around it.
31238: You should upgrade Endoscopic Control of Nasal Hemorrhage with Modifier 22. You can report 31238 for endoscopic transnasal sphenopalatine artery ligation appended by modifier 22.
But even though 31238-22 is a practical and accurate coding choice, payer reimbursement may be lower than what surgeons feel is constant with the associated physician work: about $200.46.
31299: You may also choose to go for unlisted procedure code 31299. Some coders would actually recommend this option; however you should be careful of the mistakes. They need appeal with documentation explaining what was done.
Documentation requirements may prove to be difficult. Practices aren't sure about what charge to attach to the unlisted code. While declaring a charge benchmark, you should choose a reasonably close existing code and give justification for its use.
Some experts are of the opinion that an unlisted code when carrying out a procedure that has a CPT code for an open approach however doesn't have a CPT code for an endoscopic approach.
Tip: While submitting an unlisted code, make it a point to ask your physicians to include information at the top of the operative note explaining the procedure and listing a comparable procedure and code for setting payment.
Also, make a habit of attaching a detailed operative note to your claim since it'll be subjected to a strict medical review. What's more, a cover letter explaining in lay language what services were carried out and the justification for the charge submitted could help you escape potential denial or audit.
CPT Coding for Sphenopalatine Artery Ligation