AAO Explains It All: 2011 ENT Changes

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) rushed to provide guidance coders need to accurately code 2011 claims based on information in the Medicare Physician Fee Schedule (MPFS), published Nov. 24 in the Federal Register.

When developing the  2011 MPFS final rule, the Centers for Medicare & Medicaid Services (CMS) considered American Medical Association (AMA) Relative (Value) Update Committee (RUC) recommendations for 204 new, revised, deleted, and possibly misvalued codes. Among the many code changes are three Category I CPT® codes for the use of standalone balloon sinus dilation technology during endoscopic sinus surgery.

The AMA accepted these new code proposals and recommended work and practice expense relative value units (RVUs) to CMS for the new codes. According to AAO-HNS, these codes were incorporated into CPT® 2011 as follows:

  • 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, balloon dilation), transnasal or via canine fossa (Do not report 31295 in conjunction with 31233, 31256, 31267 when performed on the same sinus)
  • 31296 with dilation of frontal sinus ostium (eg, balloon dilation) (Do not report 31296 in conjunction with 31276 when performed on the same sinus)
  • 31297 with dilation of sphenoid sinus ostium (eg, balloon dilation) (Do not report 31297 in conjunction with 31235, 31287, 31288 when performed on the same sinus)

The work RVUs of these codes as adopted by CMS in the 2011 MPFS final rule are 2.70 for 31295, 3.29 for 31296, and 2.64 for 31297.

Read “Coding for Balloon Sinus Dilation 2011” on AAO-HNS’ website for more information (registration not required).

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