Can you tell me why CPT 31237 is bundled into the sinus codes? We performed 31237, to remove the nasal polyps, and then 31254 for the endoscopic anterior ethmoidectomy on the same side. The payor denied 31237 as inclusive to 31254 and I don’t know why.
The payor is correct – 31237 is indeed included in 31254 (and the other endoscopic surgical sinusotomy codes) when performed on the same side. Removing nasal polyps is considered “access,” or part of the approach, to the sinuses. The value for the endoscopic sinusotomy codes are valued to include removal of nasal polyps so it is considered “double billing” to also report 31237.
Also, note that the CPT descriptor for 31237 includes the parenthetical statement “separate procedure.” This means that 31237 may be reported if it is the only procedure performed in the area but is included in a “larger” procedure performed at the same time in the same area.