Here's how to code and bill for endoscopic sinus surgery, a task made easier when your docs provide comprehensive documentation.

• Nasal hemorrhage. To select the correct code for control of nasal hemorrhage, you need to know whether the hemorrhage is anterior or posterior. If anterior, was the hemorrhage simple or complex? If posterior, was the control of the hemorrhage an initial or subsequent procedure?

When an endoscopic control of epistaxis is unrelated to an endoscopic polypectomy that you perform during the same session, report CPT codes 31238 (endoscopic control of epistaxis) and 31237 (endoscopic polypectomy) appended with modifier ?59. But if a polypectomy or biopsy causes subsequent bleeding and you control the bleeding during the operative session, don't report code 31238 separately for the control of epistaxis.

• Turbinate surgery. Turbinates (also called nasal concha) are bony plates covered by spongy mucosa with curved margins. Resection of the middle turbinate is generally performed for endoscopic treatment of enlargement with pneumatization and is reported using code 31240 (nasal endoscopy with concha bullosa resection). If this turbinate is removed in association with ethmoidectomy, it should be considered integral to that resection and not reported separately.

The middle and superior turbinates are rarely treated with cautery or ablation, nor are they laterally fractured. For this reason, in 2006, cross-references have been added to state that fracture, cautery or oblation of superior or middle turbinates is reported with the unlisted nose procedure code 30999. A cross-reference has also been added following code 30801 (cautery and ablation of inferior turbinates) to direct the user to the appropriate range of codes to report cautery for control of nasal hemorrhage (30901 through 30906).

The superior turbinate is usually resected only with ethmoidectomy and not separately reported. When reporting 30130, 30140, 30801, 30802 and 30930, note that these codes are unilateral because there are three turbinates in each right and left nasal cavity. If the turbinate procedure was performed to gain access to the ethmoid bone, you wouldn't typically report 30130, 30140 or 31240.

When reporting submucous turbinate resection code 30140, documentation in the operative report should reflect that the physician entered or incised the mucosa and for the most part preserved it. It's not enough to say "excised the turbinate(s)" to reflect that you performed the submucous resection of the inferior turbinate. Coders may need to ask the physician for the specific technique he performed.

Don't report 30930 with submucous resection code 30140 if the surgeon performs the procedures on the same turbinate. Be sure to include the appropriate diagnosis for performing the turbinate procedure, such as hypertrophy with airway obstruction.

• Functional endoscopic sinus surgery. Use codes 31233 to 31294 to report unilateral procedures unless otherwise specified. Codes 31254, 31255, 31256 and 31267 include uncinate process removal. The reference to "tissue" such as in code 31267 (endoscopic maxillary sinus antrostomy with removal of tissue) can include polyps, mucous membrane, bony partitions or massive fungal concretions or debris.

Consider using an unlisted procedure code for endoscopic turbinectomy. The AMA recommends that you append the unusual procedural services modifier ?22 to the FESS code when you perform both a FESS procedure and an endoscopic turbinectomy. Report code 31237 (without a modifier) each time you perform a post-operative endoscopic debridement (without a biopsy or polypectomy) following FESS.

Code 61795 describes computer-assisted planning for stereotactic surgery. This planning may take one hour to two hours and includes determination of the coordinates for the target measurement of the AC-PC line and angle calculation. A computer helps the physician select the specific trajectory and calculate the entry point through the skull. Report code 61795 (stereotactic computer assistance) when performed in conjunction with ENT, head and neck procedures, including FESS. Examples would include those procedures described by codes 31254-31256, 31267, 31276, 31287, 31288, 31290-31294 and 61548.