ENT Billing Best Practices: Procedures, Surgery, and Office Visits
Proper billing and coding in otolaryngology (ENT) is crucial for accurate reimbursement and maintaining compliance. Many ENT practices perform a variety of in-office procedures, diagnostic evaluations, and complex surgeries. Knowing how to code and document everything properly can really make a difference, it helps reduce claim denials and boosts your collections. Whether you’re a billing specialist, provider, or practice manager, this guide offers best practices for billing ENT procedures, surgeries, and consultations in 2025.
Accurate Billing for ENT Office Visits
ENT practices frequently perform consultations, follow-ups, and new patient evaluations, which fall under Evaluation and Management (E/M) codes. Choosing the correct level of service depends on the complexity of the visit, medical decision-making, and time spent with the patient. Since 2021, E/M coding has relied more on medical decision-making or total time rather than just physical exam elements.
For example, if an ENT specialist evaluates a patient for chronic sinusitis, the level of service billed must reflect whether imaging, endoscopy, or referrals were discussed. It is important to clearly document all relevant history, exam findings, and treatment plans in the medical record to support the chosen E/M code.
Common E/M CPT codes include:
- 99202–99205 for new patient office visits
- 99212–99215 for established patient office visits
When diagnostic procedures such as nasal endoscopy or flexible laryngoscopy are performed during the visit, they can be billed separately if they are medically necessary and not bundled into the E/M service. Documentation must justify their use and show they were not performed solely for diagnostic confirmation of the presenting complaint.
In-Office ENT Procedures and Diagnostic Services
Many ENT services occur within the clinic setting, including nasal endoscopy, cerumen removal, flexible laryngoscopy, and biopsies. Accurate coding for these procedures requires attention to the CPT code specifics and payer requirements.
Some frequently used ENT procedure codes include:
| Frequently Used ENT Procedure Codes | Description |
|---|---|
| 31231 | Nasal endoscopy, diagnostic, unilateral or bilateral |
| 31575 | Laryngoscopy, flexible fiberoptic |
| 69210 | Removal of impacted cerumen (requires instrumentation and documentation of necessity) |
| 30130 | Excision inferior turbinate (when performed for obstruction or hypertrophy) |
If multiple procedures are performed during the same encounter, appropriate use of modifiers is essential. For example, Modifier 59 should be used to indicate that a procedure is distinct and separate from another on the same day. However, misuse of this modifier is a common reason for payer audits and denials.
Surgical Billing – Sinus Surgery, Tonsillectomy, and More
ENT surgeons perform a wide variety of outpatient and inpatient procedures, ranging from sinus surgeries to tonsillectomies, ear tube insertions, and head and neck tumor excisions. Surgical billing in otolaryngology requires special attention to CPT coding accuracy, global periods, and bundling rules.
When billing for sinus surgery, for instance, coding depends on the specific sinuses addressed (frontal, ethmoid, sphenoid, or maxillary), whether it is unilateral or bilateral, and the technique used.
Examples of common CPT codes for ENT surgeries include:
| CPT Code | Description |
|---|---|
| 31254 - 31276 | Functional endoscopic sinus surgery (FESS) |
| 42820 | Tonsillectomy and adenoidectomy, younger than age 12 |
| 69436 | Tympanostomy (ear tube insertion)with general anesthesia |
| 30520 | Septoplasty |
Each of these procedures comes with a designated global surgical period, typically 10 or 90 days, during which follow-up care is included in the reimbursement. Billing a separately identifiable E/M service during the global period requires Modifier 24 with supporting documentation of a different diagnosis or unrelated concern.
ENT Modifier Usage and Global Period Considerations
Modifiers are crucial in ENT billing when multiple procedures are performed or when services occur during a global period. Here’s how to use some of the most relevant modifiers correctly:
| Modifier | Description |
|---|---|
| Modifier 25 | Used when a significant, separately identifiable E/M service is performed on the same day as a procedure. |
| Modifier 59 | Indicates that two procedures are distinct and not bundled under NCCI edits. |
| Modifier 51 | Denotes multiple procedures performed during the same session (used when two procedures are commonly billed together). |
| Modifier 24 | Used for unrelated E/M services during a postoperative period. |
Failure to use these modifiers correctly can lead to denials or payment delays. Always reference payer-specific modifier policies and stay updated on changes to CCI edits.
Telehealth and ENT Billing in 2025
With telehealth continuing to expand post-pandemic, ENT practices may offer virtual consultations for follow-ups, medication adjustments, or review of diagnostic imaging. When billing telehealth visits, make sure to:
- Use the appropriate telehealth CPT codes, such as 99212–99215
- Append Modifier 95 for real-time audio-visual visits
- Include the correct Place of Service (POS) code (usually POS 02 for telehealth)
Reimbursement rates for telehealth visits often vary by payer, and not all services are covered, so it’s important to verify patient benefits beforehand.
Documentation Best Practices for ENT Billing
Strong documentation is the backbone of compliant and successful ENT billing. To reduce denials and support the level of service billed, the documentation must clearly show:
- Medical necessity of all procedures and tests
- Detailed description of symptoms and diagnostic findings
- Specific anatomic site, laterality (right/left/bilateral), and method used
- Patient consent when required
- Reason for performing multiple procedures during one encounter
When documentation is vague or inconsistent, claims are at higher risk for denial, underpayment, or recoupment during audits.
Conclusion
Billing for ENT services in 2025 demands more than just knowledge of CPT codes. It requires a strategic approach to documentation, compliance with global period rules, careful modifier usage, and adaptability to evolving payer policies. Whether you’re handling routine office visits, sinus surgeries, or telehealth consultations, accurate and consistent billing practices can help your ENT practice improve collections, minimize denials, and stay audit-ready.
Want expert help optimizing your ENT billing process?
MaxRemind can help you streamline coding, improve claim acceptance rates, and ensure you never leave revenue on the table. Get in touch with our specialists today for a personalized billing audit or consultation.