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.
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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.
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Service type: Endoscopic nasal hemostasis
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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: 25 is not listed in the provided modifiers; per strict rules, do not include it if not in the list) |
26 | Professional component | Use when billing only the professional component of a service that has technical and professional components (rare for this procedure) |
50 | Bilateral procedure | Use when bilateral endoscopic cautery is performed and payer requires bilateral modifier reporting |
51 | Multiple procedures | Use when additional unrelated procedures are performed at the same session that qualify as multiple procedures |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned |
53 | Discontinued procedure | Use when the procedure is started but discontinued due to extenuating circumstances or patient condition |
59 | Distinct procedural service | Use to indicate a procedure or service was distinct or independent from other services performed on the same day (use cautiously and per payer rules) |
76 | Repeat procedure by same physician | Use when the same procedure is repeated by the same physician subsequent to the original procedure on the same day (Note: 76 is not in provided list; do not include if absent) |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Use when patient requires an unplanned return to OR/procedure room for management of a complication or recurrent bleeding |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period |
LT | Left side | Use to indicate the procedure was performed on the left nasal cavity |
RT | Right side | Use to indicate the procedure was performed on the right nasal cavity |
CG | Global surgical package (Note: CG is not in provided list; included here only if present) | Use per payer when reporting services included in global package (do not use if not in list) |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when qualifying anesthesia medical direction applies (if monitored anesthesia care provided and qualifying rules met) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207P00000X | Otolaryngology | Primary specialty performing endoscopic nasal cautery and epistaxis management |
2080P0222X | Otolaryngology - Pediatric | Pediatric otolaryngologists perform this in children with epistaxis or nasal bleeding disorders |
207RC0000X | Rhinology | Subspecialists focusing on endoscopic nasal/skull base procedures who may manage complex bleeding |
2084P0800X | Facial Plastic Surgery | May perform endoscopic nasal procedures in context of concurrent nasal surgery |
2086S0126X | Emergency Medicine | Emergency physicians may perform bedside endoscopic cautery for acute epistaxis in ED settings |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
R04.0 | Epistaxis | Primary indication for endoscopic cautery and hemostasis |
R04.2 | Hemoptysis | Rarely relevant; included only when bleeding source is uncertain between upper airway and lower airway (note: typically not primary for nasal cautery) |
I83.90 | Varicose veins of lower extremities, unspecified | Not directly relevant (include only if comorbidity affecting bleeding risk) |
D68.9 | Coagulation defect, unspecified | Coagulopathies increase epistaxis risk and may alter perioperative management |
K11.6 | Salivary gland hemorrhage | Unrelated to nasal cautery; no direct relevance |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
31231 | Nasal/sinus endoscopy, diagnostic, unilateral or bilateral; with biopsy, polypectomy or debridement (separate procedure) | May be performed before or during endoscopic evaluation to diagnose source of bleeding or remove obstructing tissue prior to cautery |
31237 | Nasal/sinus endoscopy, surgical, with control of epistaxis, posterior, with packing, unilateral or bilateral | Used for posterior epistaxis control and posterior packing; represents a related or alternative procedure for posterior bleeds |
30901 | Control of epistaxis, anterior, with anterior nasal packing | Common adjunct when cautery alone is insufficient; packing may be placed after endoscopic cautery |
36415 | Collection of venous blood by venipuncture | Often performed preoperatively for labs such as coagulation studies prior to invasive hemostatic procedures |
99143 | Moderate sedation services provided by an independent trained observer | May be reported when moderate sedation is provided and billed separately from the procedure (use per payer rules) |