tci Outpatient Facility Coding Alert - 2014 Issue 12

Reader Question: Find Out Whether 31295 Is Coupled With Another Procedure

Question: One of our third-party insurers has sent two denials for claims with code 31295 on the grounds of it being investigational. The hospital got paid and we did not. Do you have any suggestions? North Carolina Subscriber  Answer: If your physician performs 31295 (Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium [e.g., balloon dilation], transnasal or via canine fossa) at a hospital, you'll only get a small reimbursement and the hospital will be paid for the actual balloon.   If the surgeon performed only a balloon dilation of the maxillary sinuses without removing tissue, you are...

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