tci Outpatient Facility Coding Alert - 2019 Issue Q4

Reader Question: Understand Full Meaning of Separate Procedure

Question: Our payer is stating that 31231 and 31237 cannot be billed together on the same date of service (DOS). How should I get both procedures paid? Montana Subscriber Answer: Have a look at each respective code description: 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)) 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)). The first thing you’ll notice is that each respective code has the phrasing “separate procedure” included in the code description. Before checking National Correct Coding Initiative (NCCI) edits, there are a few details about separate procedure codes you should...

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