Healthcare Fraud Shield’s Latest Article: A Nasal Endoscopy is Nothing to Sneeze at!

29 Aug

If you have ever suspected your cold is “more than just a cold” and gone to our doctor, you may have experienced your doctor using a device to look at the sinus passages of the nose.  This is known as an anterior rhinoscopy or nasoscope.  While it is provides the physician with additional information in assessing your presenting complaint, this examination is limited to observations about the nasal secretions; swelling of the turbinate structures; description of the mucosal surface; position of the nasal septum; and presence of ulcerations and/or foreign bodies.  The inner aspects of individual structures within the nasal cavity is not accessible by this means.  With the introduction of nasal endoscopies as a safe, minimally invasive diagnostic tool a few decades ago, this procedure, billed as CPT code 31231, has become a frequently performed service among ENT (Ear, Nose and Throat) specialists.

According to the American Rhinologic Society, “The nasal endoscope is a medical device consisting of a thin, rigid tube with fiberoptic cables for bringing in light. The endoscope is then connected to a light source and a video camera to project magnified images on a screen.“[i]

What to look for in the Medical Record

Documentation for a nasal endoscopy should demonstrate a diagnostic procedure separate from an anterior rhinoscopy, which is a component of an Evaluation and Management (E/M) exam.   The following chart provides guidance in determining if documentation supports an anterior rhinoscopy exam or a nasal endoscopy procedure [ii]

Anterior Rhinoscopy Nasal Endoscopy
A component of the physical exam for E/M Separate from the physical exam for E/M
No preparation necessary Look for documentation of topical anesthesia and administration of decongestant prior to the procedure
Typically a nasoscope or rhinoscope Use of instrumentation:  Rigid or flexible endoscope
Limited to what is visible with an external light and a front (anterior) view Fiber-optic light with high-definition camera, able to visualize in detail each individual nasal/sinus structure and cavity
Documentation will be general in nature Documentation will include specificity and laterality of all structures within the nasal/sinus region
An accompanying drawing of structures visualized is not uncommon, but not typically required. High-definition photographic images are a component of documentation for this procedure and should be readily available for audit, if requested
No documentation of patient response is required Documentation of patient response (such as bleeding, etc) should be reported.

How is it billed?

A nasal endoscopy exam includes a pre- and post- examination by the physician.  A separate E/M is not to be billed on the same date of service, unless the medical record clearly documents that a significant, separately identifiable E/M was performed, and appended with modifier -25.  As a reminder, refer your respective company’s policies for information regarding documentation, billing, and any additional requirements such as supporting diagnoses and more.

Red Flags in the data

  • Non-ENT specialists billing nasal endoscopies – CPT 31231
  • Excessive number of patients with endoscopies compared to peers
  • Excessive number of endoscopies per patient compared to peers

For more information, or if you have any questions or comments, please contact us at

[i]American Rhinologic Society definition of nasal endoscopy

[ii]Physical Examination

If you have questions or comments, reach out to one of our subject matter experts at

If you would like to learn more about Healthcare Fraud Shield’s analytics solution, contact us at

%d bloggers like this: