Nasal Endoscopy Billing Patterns: A Survey of the American Rhinologic Society

Am J Rhinol Allergy. 2018 Jul;32(4):330-336. doi: 10.1177/1945892418773570. Epub 2018 May 7.


Introduction Nasal endoscopy (NE) is an essential element of office-based clinical rhinology, including the evaluation of chronic rhinosinusitis. Despite the presence of guidelines, variability exists regarding coding and billing for NE especially with regard to inclusion of evaluation and management (E&M) codes and use of the 25 modifier. The goal of this survey was to assess the billing patterns for NE among American Rhinologic Society (ARS) members. Methods An invitation to participate in a web-based survey was electronically sent to all ARS members. Survey participants were queried regarding demographics and billing patterns for NE in several different clinical scenarios using a 5-point Likert-type scale, with a score of 5 representing "always" and a score of 1 representing "never" for billing E&M. Results A total of 93 respondents successfully completed the survey with a range of the number of years since completing training, practice type (50.5% private, 44.1% academic) and completion of a rhinology fellowship (40.9%). Variable responses for billing patterns for distinct clinical scenarios were noted. Higher scores for billing both E&M and NE for the queried clinical scenarios were noted for new patients (mean 4.50) compared to established patients (mean 3.81) and postoperative patients (mean 3.04). Inclusion of a septoplasty as part of the surgery impacted billing an E&M code 28% of the time. Practice type and history of performing a fellowship did not significantly influence billing patterns for NE. Conclusions Significant variability exists among ARS respondents with regard to billing patterns for NE, despite the presence of coding guidelines. Additional teaching of standard coding practices for NE may limit variability among otolaryngologists.

Keywords: 25 modifier; billing and coding; chronic rhinosinusitis; evaluation and management; nasal endoscopy; survey.

MeSH terms

  • Chronic Disease
  • Endoscopy / economics*
  • Fees and Charges
  • Humans
  • Nose / surgery*
  • Otolaryngology / economics*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Rate Setting and Review
  • Rhinitis / economics*
  • Rhinitis / surgery
  • Rhinoplasty / economics*
  • Sinusitis / economics*
  • Sinusitis / surgery
  • Societies, Medical
  • Surveys and Questionnaires
  • United States