Otolaryngology Coding Alert

Find out which codes to turn to for PROPEL^® and SINUVA^® in lieu of J7401.

Over the last couple of years, there has been an uptick in the use of drug-eluting sinus implants, such as PROPEL^® and SINUVA^® stents, after sinus surgery. But, as with all new and emerging medical technologies, coding for these interventions has evolved and coders need to stay on top of these changes.

Context: In 2021, the Centers for Medicare and Medicaid Services (CMS) discontinued the original shared HCPCS Level II code J7401 for SINUVA^® and PROPEL^® and rolled out its replacements. This added to the confusion surrounding when and how to report these steroid-releasing implants.

To make sure you’re up on the latest in coding PROPEL^® and SINUVA^® drug-eluding stents (DES), we’ve put together this handy guide to help you report these implants correctly every time.

Get to Know These DES Sinus Implants

SINUVA^® is a corticosteroid-eluting implant for the treatment of nasal polyps in adult patients who have had ethmoid sinus surgery. Some otolaryngologists may suggest this as an effective form of supplementary postsurgical treatment. Placing this self-expanding, bioabsorbable implant in the sinus cavity being treated for polyps allows for the targeted delivery of an anti-inflammatory (mometasone furoate) for up to 90 days directly to the site of disease, reducing polyps and the need for revision nasal surgery.

PROPEL^® is a corticosteroid-eluting implant that mechanically props open the sinuses to maintain patency and gradually delivers mometasone furoate directly to the sinus lining as the implant dissolves, reducing inflammation and scarring after surgery. PROPEL^® is indicated for the ethmoid sinus; PROPEL^® Mini is indicated for the ethmoid and frontal sinuses; and PROPEL® Contour is used to maintain sinus patency after frontal or maxillary sinus surgery.

Typically, PROPEL^® is inserted at the time of surgery as an adjunct surgical supply, whereas SINUVA^® is inserted in the office setting after the patient has undergone prior ethmoid sinus surgery. PROPEL^® insertions usually take place in an outpatient facility or ambulatory surgical center (ASC).

Context is crucial in understanding what to do when a provider decides to use one of these implants. We’ll delve into the details of DES implantation procedural coding in the article “Peruse the Particulars of Coding DES Placement,” which you can find in this issue of Otolaryngology Coding Alert. But first, let’s take a look at covered diagnoses and the codes used to report the DES.

Submit These Codes for SINUVA^®

Patients are eligible for SINUVA^® treatment as long as they are age 18 and above with a history of ethmoid sinus surgery. The coding for SINUVA^® is relatively simple. You’ll bill the SINUVA^® administration along with one of the following nasal polyp ICD-10 codes:

• J33.0 (Polyp of nasal cavity)
• J33.1 (Polypoid sinus degeneration)
• J33.8 (Other polyp of sinus)
• J33.9 (Nasal polyp, unspecified)

You’ll report HCPCS Level II code J7402 (Mometasone furoate sinus implant, (sinuva), 10 micrograms) in addition to the underlying procedure code for the placement of the SINUVA^® implant. When placed bilaterally, you should report J7402 with two units. You’ll also add the National Drug Code (NDC) 10599000301 in Box 19 of the CMS1500 claim form.

“With the dedicated and updated SINUVA code, J7402, and a specific PROPEL code, S1091, payers can now more accurately delineate and reimburse based upon the specific use of each product,” said Thomas A. West, chief executive officer of Intersect ENT. “Moreover, payers can accurately align each product’s National Drug Code to the product-specific, CMS-assigned code and the product’s actual use,” according to West.

Observe Your Options When Coding PROPEL^®

HCPCS Level II code reporting for the three PROPEL^® sinus implants will depend on the place of service and payer:

Hospital setting: For PROPEL^® insertion in a facility, most commercial payers will expect you to report S1091 (Stent, non-coronary, temporary, with delivery system (propel)). Since government payers do not recognize “S” codes, you’ll submit C2625 (Stent, non-coronary, temporary, with delivery system) to Medicare Part B and Medicaid (and possibly other payers that have their own rules or contract stipulations).

Office setting: You’ll still submit S1091 to most commercial payers for implants placed in an outpatient setting. You’ll shift to J3490 (Unclassified drugs) for Medicare, Medicaid, and commercial payers that do not accept the “S” code. When you use J3490, you’ll also report one of the following three drug codes in item 19 of the CMS1500 claim form, 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)

When your ENT performs these procedures bilaterally, you should report two units in the appropriate field on the claim, along with the stent code (e.g., J7402, S1091, C2625).

Remember: Medicare and many commercial payers do not allow separate reimbursement for implants or supplies. You still need to include the device on your claim, however, to fully document the service and allow for data collection that might lead to reimbursement or other codes in the future.

Look to the following ICD-10 codes classified under J32.- (Chronic sinusitis) when reporting PROPEL^®, PROPEL^® Mini, and PROPEL^® Contour:

• J32.0 (Chronic maxillary sinusitis)
• J32.1 (Chronic frontal sinusitis)
• J32.2 (Chronic ethmoidal sinusitis)
• J32.3 (Chronic sphenoidal sinusitis)
• J32.4 (Chronic pansinusitis)
• J32.8 (Other chronic sinusitis)
• J32.9 (Chronic sinusitis, unspecified)

And don’t forget: “When an [PROPEL^®] implant is placed as an adjunct procedure, no additional codes should be reported to describe the work of implant placement because the implantation is included in the ethmoidectomy, the maxillary antrostomy, or the frontal sinusotomy,” notes Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, AAPC Fellow, of CRN Healthcare Solutions in Tinton Falls, New Jersey