I did a nasal endoscopy (31231) and adenoidectomy (42830) on a young child. The insurance company denied the nasal endoscopy but paid on the adenoidectomy. I wouldn’t think these two codes are bundled. What do you think?
To answer your question, we requested the operative report from you to see what the documentation says. Your note lists “adenoid hypertrophy” as a pre- and post-operative diagnosis. The body of the operative report states: “The nasal endoscope was placed down into the posterior nasopharynx and there was a large adenoid pad. There was clear mucoid fluid around the bilateral nasal cavities.” Then the operative report describes the adenoidectomy procedure.
It appears that the nasal endoscopy was a diagnostic procedure to confirm the pre-operative diagnosis of adenoid hypertrophy. The diagnostic nasal endoscopy procedure was followed by a more definitive surgical procedure (adenoidectomy). Therefore, only the definitive procedure – the adenoidectomy – is reported. It would not be appropriate to bill for the nasal endoscopy (31231) in this scenario.