Otolaryngology Coding Alert

Question: A Lynch-type transorbital frontal sinusotomy is performed on a severely mentally retarded patient. Intranasal silastic sheeting is sewn into place to avoid removal by the patient. The otolaryngologist removes the packs during post-op but is unable to remove the silastic sheeting in the office, due to the patient's condition. As a result, the patient was returned to hospital two weeks later and placed under general anesthesia to allow the sheeting to be removed. How should both placement and removal of silastic sheeting be coded?

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Answer: Silastic sheeting is placed into the sinus cavity, or occasionally in the middle ear, to prevent adhesions. The placement of the sheeting, which acts as a stent, is included in the frontal sinusotomy code (31075, sinusotomy, frontal; transorbital, unilateral [for mucocele or osteoma, Lynch type]) and should not be reported separately.
 
In some cases, such as patients with septal perforations, the otolaryngologist may bring the patient to the operating room only to place the sheeting. Because a more complex procedure is not performed, the placement is separately payable. There is no code for silastic splint placement, so use the code for examination under general anesthesia, 92502 (otolaryngologic examination under general anesthesia).
 
The removal of the sheeting was performed during the global period of the 31075, so no examination code may be separately billed. If the sheeting was removed after the global period for the sinusotomy, use 92502. If an endoscope is used, report 31231 (nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]). If debridement is also performed, report 31237 (nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]).