Wiki Balloon dilation 31295-31297 and FESS

[kathymoon]

I'm very new at ENT coding and I would like some input from those a little more knowledgeable in this area. Out-patient surgery at the hospital. I am coding the professional components.

Dr. states that bilateral frontal balloon sinuplasties were performed and irrigated with saline. Next, bilateral sphenoid balloon successful on right but left ostium was never positively identified. Some mucoid material returned. Next, bilateral maxillary balloon without difficulty.
Next, bilateral anterior and posterior ethmoidectomies were performed using Blakesley forceps.

The office manager for ENT told me we NEVER bill balloon sinuplasties in the hospital. They are only done in the office. That the balloon is only a tool for the FESS. But three different areas were dilated. Do I code this with just the 31255 and none of the balloons? Needless to say, I need a class in ENT surgeries.

Thank you for your assistance.

 

[scadykat]

Kathy,
You can code Balloon Dilation (31295, 31296, 31297) in an outpatient or office setting. Maybe your supervisor was trying to say that you cannot bill Balloon Dilation codes with FESS codes. (ex: 31296 cannot get billed with 31276). Hope this helps.

 

[kathymoon]

Kathy,
You can code Balloon Dilation (31295, 31296, 31297) in an outpatient or office setting. Maybe your supervisor was trying to say that you cannot bill Balloon Dilation codes with FESS codes. (ex: 31296 cannot get billed with 31276). Hope this helps.

Kathy,

So just to clarify, you cannot bill any of the balloon dilations with a FESS. The physician did all three during the procedure. Hopefully, not making you repeat yourself, but I am feeling a little unknowledgeable (is that a word) at this time.

Thank you so much for your help.

 

[Candice_Fenildo]

Kathy, Hi, You cannot code a "Pure" balloon CPT code ( 31295-31297) with "Tradition" sinus codes ( 31267,31276,31288,361287,31256,) what this means is, if the operative note states that their was tissue removal during the sinuplasty, then the balloon may have been used just as a "tool" to open the sinus Ostia and therefore you would refer to the traditional sinus codes. Sometimes, the sinuses just need to dilated and rinsed. this is when you would only code the balloon codes ( 31295-31297). I hope this helps you understand. If you want to de-identify the operative note and email it to me, I can look at it and break it down for you.

 

[Stacey Walden]

Billing 31295, 31296, 31297

We billed bilateral 31295, 31296 & 31297 to medicare and they are indicating they will not allow this many/frequency of services. We used a modifier 59. Is this not appropriate?