Coding 3 or 4 Sinuses Using FESS Codes

Coding 3 or 4 Sinuses Using FESS Codes

A lot of people have been asking questions about how to code FESS surgeries with the new combination codes when three or four sinuses are operated on.

Sinus and FESS

We have been expecting an AMA CPT® Assistant article with guidance this year, but no instructions have come from the AMA.  I went to the relative values assigned to the FESS surgeries to determine which combination codes should be used and which codes should be billed by themselves. I looked at scenarios where one of the FESS surgeries is the primary surgery, paid at 100 percent, and considered if a septoplasty is also performed and all the FESS surgeries are secondary surgeries, subject to multiple surgery discounts.

Either way I calculated it, the same answer was obvious.  That answer was that the practice is better off using the combination code that bundles the total ethmoidectomy and the sphenoid sinus surgery and carving out the frontal sinus surgery as a separate code.  Even when subject to multiple procedure discounts, 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed is best billed by itself and the endoscopic sphenoid sinus surgery is best coded with the total ethmoidectomy, as either 31257 or 31259.

Understanding Sinus RVUs

Below are calculations that I made showing the different ways the three sinuses can be coded for the ethmoids, sphenoids, and frontals.  The calculations show that even when all the FESS codes are subject to multiple surgery discount reductions, billing the frontal sinuses separately with 31276 will net more relative value units for the practices than if the frontal sinuses are combined with the total ethmoids via 31253.  These results come out the same when a FESS surgery is the major surgery as well as when the FESS surgeries are performed bilaterally on all three sinuses.  The relative values speak to us and tell us that it is better for the practices to bill the combination code which bundles the total ethmoids and sphenoids (31257 or 31259) and bill the frontal endoscopic sinus surgery separately to optimize RVUs to the practice.

The below chart shows the various way that the RVUs are calculated and show the outcome described above.

 

CPT® Description RVUs
31253 Total ethmoid w/frontal 14.38
31257 Total ethmoid w/sphenoid 12.8
31259 Total ethmoid w/sphenoid with rem tissue 13.57
31276 Frontal 10.85
31287 Sphenoid 5.78
31288 Sphenoid with removal of tissue 6.72
30520 Septoplasty 17.43
FESS Total ethmoidectomy, frontal and sphenoid
31257 12.8
31276 50% of 10.85 =                                            5.43
Total 18.23 RVUs
OR
31253 14.38
31287 50% of 5.78=                                                2.78
Total 17.27 RVUs
FESS Total ethmoidectomy, frontal and sphenoid with removal of tissue
31259 13.57
31276 50% of 10.85=                                             5.43
Total 19 RVUs
OR
31253 14.38
31288 50% of 6.72=                                                3.36
Total 17.74 RVUs
Septo/FESS Total ethmoidectomy, frontal and sphenoid
30520 17.43
31257 50% of 12.8 =                                                 6.4
31276 50% of 10.85 =                                            5.43
Total 29.26 RVUs
OR
30520 17.43
31253 50% of 14.38 =                                             7.19
31287 50% of 5.78=                                                2.78
Total 27.40 RVUs
Septo/FESS Total ethmoidectomy, frontal and sphenoid with removal of tissue
30520 17.43
31259 50% of 13.57=                                             6.79
31276 50% of 10.85=                                             5.43
Total 29.65 RVUs
OR
30520 17.43
31253 50% of 14.38=                                            7.19
31288 50% of 6.72=                                                3.36
Total 27.98 RVUs

 

 

 

 

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

Latest posts by Barbara Cobuzzi (see all)

About Has 44 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.

Leave a Reply

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