Otolaryngology Coding Alert

A 30465 light bulb should go off when you see -stenosis- You don't have to be a super sleuth to unravel functional endoscopic sinus surgery (FESS) operative reports if you employ these insider tactics. For optimal ENT coding, you-ve got to understand anatomic landmarks that the otolaryngologist might cite to know where in the sinuses the surgeon is working, says Joanne Schade-Boyce, RDH, MS, CPC, ASC, PCS, in AudioEducator.com's "Anatomy and Coding Essentials for Optimal FESS Reimbursement." The surgeon might note a landmark to indicate he's going into another sinus, Boyce points out. To capture codeable procedures, try these best practices. 1. Ask for a Procedure Revealing Run-Thru If your otolaryngologists are accessible to you, arm yourself with your notes, coding book and anatomy book, and ask them to talk to you about the procedures they commonly perform, suggests Schade-Boyce. "Have them walk you through how they dictate to see if there are opportunities for additional reimbursement." Heads up: Did the surgeon go through the anterior ethmoid? If he came into this sinus for medically necessary reasons, then you should bill for the ethmoidectomy (31254, Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]), Schade-Boyce says. Beware: If you spot sphenoid (31287, Nasal/sinus endoscopy, surgical, with spehnoidectomy; 31288, - with removal of tissue from sphenoid sinus; and/or 31291, Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid region) in the operative report, ask the otolaryngologist how he got there. An ethmoidectomy could be billable if it was medically necessary. But if the surgeon used the sinus as the "freeway on the way to the sphenoids," it is not a billable service. 2. Equate Stenosis With 30465 When you see "stenosis -- nasal valve" in an operative report, a light should go off in your head. You should think, "I wonder if the surgeon did 30465," (Repair of nasal vestibular stenosis [e.g., spreader grafting, lateral nasal wall reconstruction]) Schade-Boyce says. If a patient's nasal valve angle has narrowed (stenosis) to less than 10- to 15-, he may not breathe right. Code 30465 describes the techniques the surgeon might use, such as spreader grafting or lateral nasal wall reconstruction, says Amit Joshi, MSc, senior medical coder for Prexis Health India Ltd. in Pace City II, Gurgaon, India. "Osteotomy [cutting for realignment] of nasal bones is a buzz word in these types of cases." In nasal valve repair, the ENT may create a graft that he puts up into the patient's nose, like shocks lifting up a car, to open up the angle. "For instance, harvested nasal cartilage [from the patient's nasal septum] is often used as a spreader graft or as a nasal alar batten graft to repair a dysfunctional or collapsed internal [...]