New FESS Coding for 2018

New FESS Coding for 2018

AAPC’s Knowledge Center welcomes Barbara Cobuzzi as a regular contributor. 

Nasal Sinus Endoscopy

According to the American Rhinologic Society, several nasal sinus endoscopy services were identified as potentially misvalued because billing patterns revealed they were billed together more than 75 percent of the time (same beneficiary/same day of service). As a result, the specialty societies were required to ‘bundle’ services together and create new codes that represented the combined services.

When services are bundled, CMS expects to see significant reductions in wRVUs (work RVUs) to account for efficiencies.  CMS finalized 2018 values for five new nasal sinus endoscopy CPT codes (31241, 31253, 31257, 31259, and 31298) and 10 existing nasal sinus endoscopy CPT codes.    

Balloon Sinus Dilation Codes 

  CPT
Code
Descriptor 2017

wRVU

2018
wRVU
2018 Global
Period
31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, balloon dilation), transnasal or canine fossa 2.70 2.70 000
31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium (eg, balloon dilation) 3.29 3.10 000
31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid sinus ostium (eg, balloon dilation) 2.64 2.44 000
New/Bundled 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and sphenoid sinus ostia (eg, balloon dilation) *4.61 4.50 000


Functional Endoscopic Sinus Surgery (FESS) Codes

  CPT
Code
Descriptor 2017

wRVU

2018
wRVU
2018 Global
Period
31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior) 4.64 4.27 000
31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior) 6.95 5.75 000
New/Bundled 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed *12.30 9.00 000
New/Bundled 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including spehnoidotomy *8.90 8.00 000
New/Bundled 31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from sphenoid sinus *9.24 8.48 000
31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy 3.29 3.11 000
31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus 5.45 4.68 000
31276 Nasal/sinus endoscopy, surgical; with frontal sinus exploration, including removal of tissue from frontal sinus, when performed 8.84 6.75 000
31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy 3.91 3.50 000
31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus 4.57 4.10 000

 

*Computed using 2017 wRVUs and the standard multiple procedure payment reduction methodology

 

New Sphenopalatine Artery Code

 

CPT
Code
Descriptor 2018
wRVU
2018
Global
31241

New

Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery 8.00 000

 

CMS finalized direct practice expense inputs for this family of services as well as including updates to the “sinus surgery balloon (maxillary, frontal, or sphenoid) kit”. CMS included 0.5 kits for CPT codes 31295, 31296, and 31297 and one kit for CPT code 31298. The specialty societies urged the Agency to develop a standalone HCPCS Level II supply code for the balloon kit, to allow providers flexibility in reporting the quantity of actual kits used. CMS rejected the request.

Resection Inferior Turbinate (CPT  30140)

CMS finalized work and direct practice expense inputs for CPT code 30140 Submucous resection inferior turbinate, partial or complete, any method, a service that was identified as potentially misvalued on a screen of Harvard-valued codes with utilization over 30,000.  

CMS assigned a wRVUs of 3.00 for CY2018.  CMS also finalized direct practice expense inputs for CPT Code 30140, which included three new equipment codes based on the invoices submitted for this code family: a 2mm reusable shaver blade (EQ383), a microdebrider handpiece (EQ384) and a microdebrider console (EQ385). 

It is important to note that CMS changed the global period from a 090 day global period to a 000 day global period for CPT code 30140. This change in in global period from 090 to 000 will allow providers to bill for follow-up care performed. This change in global period puts 30140’s global period out of sync with the global period for the other turbinate procedures, 30130 Excision inferior turbinate, partial or complete, any method which still has 90 global days, 30801 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction; superficial and 30802 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal), both of which still have 10 global days.

 

CPT
Code
Descriptor 2017
wRVU
2018
wRVU
2017
Global
Period
2018 Global
Period
30140 Submucous resection inferior turbinate, partial or complete, any method 3.57 3.00 090 000

 

 

Barbara Cobuzzi

Barbara Cobuzzi

Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is a consultant with CRN Healthcare Solutions in Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. Barbara also provides litigation support as an expert witness for providers and payers.Cobuzzi is a member of the Monmouth, N.J., AAPC local chapter.
Barbara Cobuzzi

About Has 34 Posts

Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is a consultant with CRN Healthcare Solutions in Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. Barbara also provides litigation support as an expert witness for providers and payers. Cobuzzi is a member of the Monmouth, N.J., AAPC local chapter.

2 Responses to “New FESS Coding for 2018”

  1. MAUREEN says:

    I want to clarify the new sinus surgery codes for 2018. Doctor performed bilat total ethmoidectomy, right frontal w/removal of tissue, and right sphenoid with removal of tissue.
    There is a guide showing for FESS, when treating all 3 sinuses (frontal, ethmoid, sphenoid): Bundle ethmoid and sphenoid (31257 or 31259). Code for frontal independently (31276).
    So, then would I bill
    31276-RT
    31259-51-RT
    31255-XS-LT

  2. Barbara J. Cobuzzi says:

    Maureen,

    That looks correct. Can I conclude that the patient is a Part B Medicare patient since you used the XS modifier instead of the 59 modifier? No other payer would recognize the XS modifier, so if the patient does not have Part B Medicare, make sure you use the 59 modifier instead of the XS. This include Medicare Advantage patients as the X[ESUP] modifiers only apply to Part B insured patients, not Medicare Advantage nor privately insured patients.

    Choosing to use the bundled code of the ethmoidectomy with the sphenoidectomy with removal of tissue you are optimizing the RVUs. Please note that 31259 has higher RVUs (13.57 RVUs) than 31276 (10.85 RVUs), so 31259 would be the primary code:

    31259-RT
    31276-51-RT
    31255-XS [59]-LT

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