New FESS Codes for 2018

New FESS Codes for 2018

2018 brings us new functional endoscopic sinus surgery codes (FESS) which bundle a total ethmoidectomy with both a frontal sinusotomy and a sphenoidotomy with and without removal of tissue.  2018 CPT® also provides a new bundled code for a frontal and sphenoid endoscopic balloon dilation.  On initial review of these new codes and the instructions in the AMA CPT® code book,  it is confusing as to how to one should code when 3 or 4 sinuses are operated on the same side.

 

 

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

 It makes sense that a partial and total ethmoidectomy are bundled with the new codes, 31253, 31257, and 31259 since each of the new codes includes a total ethmoidectomy.  A maxillary antrostomy still stands alone and is not included in any of the codes, so the combination codes only include the anterior and posterior ethmoid sinuses along with the frontal and sphenoid sinuses.  So if a maxillary antrostomy is performed with a total ethmoidectomy and a frontal sinusotomy on the same side, it would be coded with the combination codes 31253 plus 31256 if no tissue was removed and plus 31267 if tissue was removed.  If a maxillary antrostomy, total ethmoidectomy, and sphenoidotomy are performed on the same side, there are a few combinations of codes that may apply, depending if tissue was taken out of the maxillary sinuses and/or sphenoid sinuses.

31257 and 31256 if no tissue was removed from either maxillary or sphenoid sinuses

31257 and 31267 if tissue is only removed from the maxillary sinus

31259 and 31256 if tissue is only removed from the sphenoid sinus

31259 and 31267 if tissue is removed from both the maxillary and sphenoid sinuses

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.

FESS Question

The question is how will it be coded if all four sinuses are operated on the same side?  The AMA should be issuing guidance for this via CPT® Assistant soon, but in the meantime, guidance from high ranking physicians of the AAO/HNS have indicated the following:

All 4 sinuses (with no removal of tissue) can be coded in one of two ways:

31253, 31287, 31256 or 31257, 31276, 31256

If tissue is removed, 31287 and/or 31256 would be replaced with 31288 and/or 31267 in the first coding combination or 31257 and/or 31256 would be replaced with 31259 and/or 31267.

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.

16 Responses to “New FESS Codes for 2018”

  1. Rosanne Darley says:

    We have contacted a few of our insurance companies and they do not have allowable for these codes new bundling codes for sinuses….. They say they are not aware of code changes. Should all insurances be aware of these changes? Is their a grace period on using these codes?

    Thank you for your help..

  2. BARBARA COBUZZI says:

    Rosanne Darley, HIPAA standardized codes sets say that payers must use the same code sets. You need to inform your payer that they have to update their systems to 2018 CPT. The only payers who are exempt from updating to the current codes are Motor Vehicle (PIP) and Workers Comp payers. They can get away with using old codes and driving you crazy. All other payers must update and use the current codes.

  3. Nicole says:

    Our Dr. is wanting to report 31298-Right, 31295-50 and 31296-Left. Is this okay to report together? I would report with LT/RT modifiers but it is a Noridian Medicare member and Medicare will not allow RT/LT modifiers. The claim will just get kicked back for invalid Modifier. Please advise.

    Thank You!

  4. Peggy Koens says:

    There still seems to be much confusion regarding how to bill these new codes for removal of tissue in all 4 sinuses. If we bill one of the two examples above(FESS Question) 31288/31267 or 31259/31267 are we being reimbursed for the frontal as well?

  5. Barbara J. Cobuzzi says:

    Peggy,
    Neither of the two examples you list (31288/31267 or 31259/31267) include the frontal sinuses. The first one includes the sphenoid and maxillary sinuses only and the second the ethmoids, sphenoid and maxillary sinuses. When billing for all 4 sinuses, you need to add 31276 to 31259 and 31267 (assuming tissue was removed from the maxillary and sphenoid sinuses)

  6. Barbara J. Cobuzzi says:

    Nicole,

    So, it appear that your provider performed a maxillary BSD bilaterally, frontal BSD bilaterally and sphenoid BSD on the left. You would report this as: (Since your Medicare carrier does not like the LT and RT modifiers, do not use them. I included them so you can see what side is being addressed
    31295-50
    31298-RT
    31296-XS-LT

    The XS is in place of a 59 modifier and refers to separate structure.. This is saying that this frontal BSD is on a separate structure than the frontal BSD is reflected from 31298.

  7. Lisa says:

    Bilateral frontal, bilateral ethmoidectomy w/removal of tissue and LT sphenoidotomy w/removal of tissue were performed. How should this be billed to a commercial insurance?

  8. Barbara J. Cobuzzi says:

    Lisa, for the bilateral frontal, bilateral ethmoid and LT sphenoidotomy with removal of tissue, I would code:

    31253-50. 150% of 12.3 RVUs
    31288-RT. 50% of 4.57 RVUs
    This will optimize payment for the surgery you describe.

    Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO

  9. Tammy says:

    Hi – I would like to make sure I understand CPT 31298. Does 31298 just include the frontal and sphenoid ? Or does it also include the maxillary ? When doing bilateral BSD I would normally bill 31298-50 and 31295-50. Is this correct ? Thank you.

  10. Barbara J. Cobuzzi says:

    Tammy,

    31298 includes a BSD of the frontal and sphenoid. If all three sinuses were dilated via balloon, you would code it 31298, 31295. If all three sinuses were dilated via balloon bilaterally, you are correct, it would be coded 31298-50, 31295-50. Make sure you link the frontal and sphenoid sinusitis diagnoses to 31298 and the maxillary sinusisits linked to 31295. Tell your doctor to list the specific sinuses that are effected and to not just list “chronic sinusitis” and/or “acute sinusitis” in the pre/post op diagnosis on the op note which would force you to use “unspecified” codes. The coder needs specific diagnoses in order to support medical necessity for the multiple BSD procedures performed.

  11. KW says:

    I did bilateral frontal and ethmoid FESS and used 31253 – 50. We received a denial stating the modifier is incorrect. We tried calling the insurance but they could not tell us how to properly bill it. Should we try:

    31253 – 51 RT
    31253 – LT

  12. Barbara J. Cobuzzi says:

    KW, The insurance company is wrong, 31253 is payable with a 50 modifier. They seem to have their computer systems set up improperly. Since you are dealing with people who do not understand the anatomy and do not have their system set up properly, you can do one of two things. I would appeal the non payment of the bilateral surgery and point out to the payer that they have their systems set up wrong. I would show them that the Medicare fee database indicates that the 50 modifier is a payable modifier when the frontal and ethmoid FESS surgery was performed bilaterallly. I would fight with the payer tooth and nail because of their inappropriate processing of the claim.

    The other way you can try to bill the surgery would be:
    31253-RT
    31253-59-LT

    I do not think the 51 modifier would get the second side paid. The 59 modifier is showing that it is a separate site.

  13. Kim says:

    What if I have Bilateral Ethmoids and a Left Frontal?

    How do I use the bundled code 31253 and specify bilateral just or the ethmoids and left just for the frontal?

  14. Barbara Cobuzzi says:

    Kim,

    For bilateral total ethmoidectomy and left frontal, you would code

    31253-LT
    31255-59-RT (If this is a Part B Medicare patient, it would be 31255-XS-RT)

  15. Tammy says:

    Hi – We have always done a sinus debridement (31237-50-79) post operative with modifier -79. They are now being denied for the procedure code is inconsistent with the modifier used or invalid modifier. We have tried -78 which now reads unplanned return to OR/Procedure room by same physician or other qualified health care professional during post op period and -78 is rejected for the same reason – procedure code is inconsistent with the modifier used . What should we be using ? Modifier -58 staged or related ? Thank you for your help. Tammy

  16. Barbara J. Cobuzzi says:

    Tammy,

    The -78 modifier would not be applicable. If the 79 modifier is not being accepted by your payer, the other alternative is the 58 modifier for staged procedure since the provider plans on doing the debridements post sinus and septum surgery. Note that 30140 has gone down to zero global days in 2018 from 90 days in 2017 or earlier. So, if your surgeon performed FESS surgery and a submucous resection of the turbinates, the surgery has zero global days in 2018. Unfortunately, if the lesser service, a coblation of the turbinates, 30802 is performed, the surgery has a 10 day global since the other turbinate codes’ global periods were not changed to be consistent with 30140.

    Make sure you pre-certify the planned debridement services. That way, when using the 58 modifier, you will have pre-notified the insurance company of your plans to perform debridements. I recommend pre-certifying the debridements no matter which modifier is used (79 or 58) because it is always better to give the insurance company the information up front and have the procedures pre-certified.

    Barbara Cobuzzi

Leave a Reply

Your email address will not be published. Required fields are marked *