Respiratory

For the Week of February 1, 2016

Is a biopsy performed in conjunction with a more extensive nasal/sinus procedure separately reportable?


The situation you describe is not separately reportable unless the biopsy is examined pathologically prior to the more extensive procedure, and the decision to proceed with the more extensive procedure is based on the result of the pathologic examination.

In Chapter 5 of the Medicare Claims Processing Manual, the Centers for Medicare & Medicaid Services (CMS) give the following as an example of the above guideline.
If a patient presents with nasal obstruction, sinus obstruction and multiple nasal polyps, it may be reasonable to perform a biopsy prior to, or in conjunction with, polypectomy and ethmoidectomy. A separate biopsy code (e.g., CPT code 31237 for nasal/sinus endoscopy) should not be reported with the removal nasal/sinus endoscopy code (e.g., CPT code 31255) because the biopsy tissue is procured as part of the surgery, not to establish the need for surgery.