Otolaryngology Coding Alert

Question: What is the correct coding for endoscopic placement of a PROPEL^® drug-eluting stent (DES) during functional endoscopic sinus surgery (FESS)? Is the placement included in the FESS? Does the coding change if the placement is a stand-alone procedure?

AAPC Forum Participant

Answer: Correct coding for the endoscopic placement of a PROPEL^® DES depends on whether the placement is a stand-alone procedure or not, as you say.

When DES placement occurs as an adjunct to a FESS procedure (31231-31298), the work associated with the implant placement is already included in the work relative value unit (RVU) calculation for that procedure. Thus, you should only bill the CPT^® code(s) relevant to the sinus procedure; do not report any additional codes to describe the work of the adjunct stent implantation.

When the placement of the DES is a separate procedure, and no other procedure is performed during the encounter, you should submit 31299 (Unlisted procedure, accessory sinuses).

As this is an unlisted code, you must make sure you include thorough documentation of your surgeon’s work and appropriate comparison information for reimbursement. For a comparison code, you can use 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)) for placement of a PROPEL^® Contour DES in the frontal sinus ostia, or 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement …) for placement of a PROPEL^® or a PROPEL^® Mini DES in either the ethmoid or frontal sinus.

Remember to Choose the Correct PROPEL^® Code

For private payers, you’ll use S1091 (Stent, non-coronary, temporary, with delivery system (propel)). However, for Medicare and private payers following Medicare guidelines, you’ll submit C2625 (Stent, non-coronary, temporary, with delivery system) since Medicare does not recognize “S” codes.

You’ll also report one of the following three drug codes depending on which implant is used:

• 10599-0000-01 – PROPEL^® (Mometasone furoate sinus implant, 370 micrograms)
• 10599-0001-01 – PROPEL^® Mini (Mometasone furoate sinus implant, 370 micrograms)
• 10599-0002-01 – PROPEL^® Contour (Mometasone furoate sinus implant, 370 micrograms)

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC