Summary & Overview
CPT 31238: Endoscopic Nasal Hemostasis
CPT code 31238 denotes an endoscopic nasal procedure in which an endoscope is inserted into the nasal cavity and bipolar cautery or similar techniques are used to control bleeding. This code captures a targeted, minimally invasive approach to diagnosing and managing intranasal hemorrhage and is relevant to otolaryngology practices, ambulatory surgical centers, and hospital outpatient departments nationwide.
Key payers referenced in analyses of this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about when endoscopic nasal hemostasis is used, typical sites of service, and the procedural intent. The publication also outlines national reimbursement benchmarks, common billing and coding considerations, and recent policy updates affecting coverage and site-of-service payment differentials. Practical takeaways include how payers commonly classify this service, typical authorization expectations, and factors that influence payment such as facility setting and documented medical necessity.
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related billing codes is noted where applicable.
Billing Code Overview
CPT code 31238 describes an endoscopic nasal procedure in which a provider inserts an endoscope into the nasal cavity and employs bipolar cautery or other means to control bleeding. This procedure is a nasal endoscopy with hemostatic control and is typically performed to identify and manage sources of epistaxis or intra-nasal bleeding.
-
Service type: Endoscopic nasal hemostasis
-
Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in-office when appropriate equipment and setting are available.
Clinical & Coding Specifications
Clinical Context
A 45-year-old male presents to the otolaryngology clinic with recurrent unilateral epistaxis unresponsive to topical measures. After topical vasoconstrictor and anterior nasal packing fail to control bleeding, the patient is scheduled for endoscopic evaluation and cauterization. In the procedure room or ambulatory surgery center, under local anesthesia with monitored sedation or general anesthesia depending on bleeding severity and patient tolerance, a nasal endoscope is introduced into the affected nasal cavity. The surgeon identifies the bleeding source (commonly Kiesselbach plexus or posterior lateral nasal branches) and applies bipolar cautery or equivalent bipolar hemostatic devices to achieve hemostasis. Hemostasis is confirmed endoscopically; anterior or posterior packing may be placed if needed. Typical documentation includes preoperative indication (epistaxis), consent, anesthesia type, operative findings, method of cautery (bipolar), laterality, estimated blood loss, complications, and postoperative instructions. Typical site of service is the ambulatory surgery center or hospital outpatient department; some cases occur in the office procedure suite when appropriate equipment and monitoring are available.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a separate E/M visit meets documentation requirements on the same day as the procedure (Note: is not listed in the provided modifiers; per strict rules, do not include it if not in the list) |