Otolaryngology Coding Alert

Be careful: Regular sinus codes don't capture the new technology's work, AAO-HNS warns
 
To protect functional endoscopic sinus surgery (FESS) code values, you have to use an unlisted-procedure code for sinus surgery using a balloon catheter. Avoid Manufacturer's -Recommendations- It's a good rule of thumb not to rely on billing advice from equipment vendors. And balloon sinuplasty coding is no exception.

Some coders and otolaryngologists heed what they interpret as the balloon sinuplasty manufacturer's recommendations and use the regular sinus codes based on the site. But coding guidelines and the American Academy of Otolaryngology -- Head and Neck Surgery (AAO-HNS) don't support this practice.

Misleading: The balloon sinuplasty manufacturer's (Acclarent) Web site indicates that hospital outpatient departments and physicians commonly bill site-specific endoscopic sinus codes for the balloon sinuplasty procedures. Providers should -select the appropriate codes and modifiers that reflect the services furnished to individual patients and follow specific payers- coding and billing instructions,- according to the Web site. Inappropriate codes the vendor listed include:

- 31254 -- Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)

- 31256 -- Nasal/sinus endoscopy, surgical, with maxillary antrostomy

- 31276 -- Nasal/sinus endoscopy, surgical, with frontal sinus exploration, with or without removal of tissue from frontal sinus

- 31287 -- Nasal/sinus endoscopy, surgical, with sphenoidotomy

- +61795 -- Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial or spinal (list separately in addition to code for primary procedure). Don't overlook: The company does warn that this list is based only on codes used for balloon sinuplasty and not on accepted policy. -The information does not constitute reimbursement or legal advice or advice about how to code for procedures,- the company stipulates. Further, the company says, -It is the provider's responsibility to determine and submit appropriate billing codes and charges that best describe the services furnished to a particular patient.-
 
Realize Balloon Sinuplasty, FESS Codes Don't Match The AAO-HNS interprets the balloon sinuplasty manufacturer's caveat as an indication that no specific CPT code exists for this new technology. In addition, -the Academy has not received a formal request from the manufacturer supporting use of approved CPT codes for FESS procedures using the balloon sinuplasty technology,- according to the AAO-HNS bulletin on the device.

Instead: The Academy recommends not using 31254-31287. -The sinuplasty procedure differs materially from the vignettes for the original endoscopic surgery codes,- states the article Task Force Formed to Review Balloon Sinuplasty Procedure.

Linguistically, reporting balloon sinuplasty with some FESS codes doesn't make sense. Here's why:

Reason 1: Codes 31254-31287 describe sinus endoscopy. -To bill regular FESS codes, your otolaryngologist needs to use an endoscope,- says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

In balloon sinuplasty, the physician threads a guidewire equipped with a balloon into the nostrils and up into the blockage, [...]