Healthcare providers use Current Procedural Terminology (CPT) codes to communicate the details of medical services to insurance companies and payers for proper reimbursement. Maintained by the American Medical Association, these standardized numerical codes translate complex surgical actions into a single, recognized value. Finding the correct CPT code for a specific surgery, such as a bilateral endoscopic nasal polypectomy, is often challenging for both patients and coders. Precise coding ensures the provider receives appropriate payment and the patient’s benefits are correctly applied. This article clarifies the specific code and the necessary addition used to report this particular surgical procedure.
Defining Endoscopic Nasal Polypectomy
Nasal polyps are soft, non-cancerous growths that develop on the lining of the nasal passages or within the sinuses. They result from chronic inflammation related to conditions like asthma, allergies, or recurrent infections. While small polyps may be asymptomatic, larger ones obstruct the nasal cavity, causing persistent congestion, difficulty breathing, facial pressure, and a reduced sense of smell.
The removal procedure, called a nasal polypectomy, is usually recommended when medications like corticosteroid nasal sprays fail to relieve symptoms. Modern polypectomy is most often performed using a minimally invasive endoscopic technique.
During the endoscopic approach, the surgeon inserts a thin, flexible tube (an endoscope) equipped with a light and camera through the nostrils. This allows direct visualization of the nasal and sinus structures without external incisions. Specialized micro-instruments are guided alongside the endoscope to remove the polyp tissue. The term “bilateral” specifies that this removal was performed on both the left and right sides of the nasal cavity during the same surgical session.
The Specific CPT Code for Polypectomy
The base CPT code for an endoscopic nasal polypectomy is 31237. This code is officially defined as “Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure)”.
The inclusion of “polypectomy” confirms this is the correct code for removing the growths. Code 31237 applies to surgical endoscopy involving tissue removal, whether for biopsy, debridement, or targeted polyp removal. It is frequently used in otolaryngology for treating chronic sinus issues and nasal polyps.
The selection of 31237 reflects the surgical complexity and the specific action performed using the endoscope. This code is used for procedures involving moderate complexity, requiring specific time and medical decision-making by the provider. When used alone, this five-digit code describes the procedure as if it were performed on only one side, which is the standard convention for most CPT codes. This base code establishes the procedure’s definition but does not account for bilateral performance.
Navigating the Bilateral Modifier
CPT codes are typically structured to represent a procedure performed on a single anatomical site or side of the body, known as a unilateral procedure. To accurately communicate that the same surgical service, such as the polypectomy defined by code 31237, was executed on both the left and right sides, a special two-digit addition called a modifier must be appended to the base code. This modifier is the key to correctly coding the “bilateral” component of the surgery.
The specific addition used is modifier -50, which signifies a “Bilateral Procedure”. When submitting the claim, the full code becomes 31237-50, which explicitly informs the payer that the endoscopic nasal polypectomy was performed on both sides during the same operative session. This is a crucial distinction for insurance processing and payment purposes.
The application of modifier -50 has a direct and predictable impact on how the claim is reimbursed by the payer, especially for government programs like Medicare. Instead of paying the full fee schedule amount for a single procedure twice, the bilateral rule generally dictates that the total payment for both sides combined will be 150% of the allowable amount for the unilateral procedure. This adjustment recognizes that while the surgeon performs twice the work, certain overhead costs, such as pre-operative preparation and anesthesia, do not double.
Some private insurance companies or specific state programs may have internal policies that prefer alternative methods instead of the -50 modifier. These alternative methods might involve reporting the base code on two separate lines, using the anatomical modifiers -RT for the right side and -LT for the left side. However, the use of 31237-50 remains the most widely recognized and standard approach for indicating a bilateral endoscopic nasal polypectomy for most major payers. Proper application of the correct modifier is necessary to ensure the claim is processed accurately and avoids automatic denial.