2023 ASC Coding Tips: Correct Reporting of Respiratory Endoscopic Procedures

By Mary Reilly, CPC, COC, CASCC, Coding Manager

A common practice in otolaryngology (ENT) is to perform multiple endoscopic procedures in one encounter to diagnose and/or treat a condition. The NCCI manual outlines rules for these procedures that may prevent them from being coded in the same encounter. Proper documentation is key in such situations as you must prove medical necessity of each endoscopy to report it separately.

Here are the NCCI rules to be familiar with to prevent upcoding.

Rule: A separate HCPCS/CPT code shall not be reported for evaluation of the access regions when a diagnostic or surgical endoscopy of the respiratory system is performed.

Commentary: It is considered standard practice to evaluate the access regions. An example is when performing an endoscopic maxillary antrostomy, a diagnostic nasal endoscopy cannot be separately reported.

Rule: If medically reasonable and necessary endoscopic procedures are performed on two regions of the respiratory system with different types of endoscopes, both procedures may be separately reportable.

Commentary: For example, if a patient requires a bronchoscopy to evaluate a lung mass and a separate laryngoscopy to biopsy a laryngeal mass, both may be reported. It was medically necessary to use two separate endoscopes to perform both procedures. This must be clearly and accurately documented to be supported. If there is not a separate indication or medically necessary reason for the diagnostic bronchoscopy in addition to a surgical laryngoscopy, then only the laryngoscopy may be reported.

Rule: If an endoscopic procedure to evaluate the surgical field (e.g., confirmation of anatomic structures, assess extent of disease, confirmation of adequacy of surgical procedure such as tracheostomy) is performed at the same patient encounter as an open surgical procedure, the endoscopic procedure is not separately reportable.

Commentary: An example of this would be a nasal endoscopy was performed to evaluate the extent of a deviated septum. An open septoplasty is then performed. The diagnostic nasal endoscopy is not separately reportable with the septoplasty.

The full extent of these rules can be reviewed online in the Medicare NCCI 2023 Coding Policy Manual, chapter V, section C, paragraph 3.