Balloon Septoplasty

ghovey

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Bettendorf
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Is anyone doing Balloon Septoplasties? Are you having any luck with reimbursements with the new codes 31295, 31296, and 31297.
 

stroschk

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Watertown, SD
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I am in South Dakota and we are having a very hard time with Wellmark (BCBS). They were paying last year when there was not a sinuplasty code which was minimal, but now are saying those CPT's are investigational and we are told that our facility has to adjust the entire portion and cannot bill the patient for any portion. THere are extremely high case costs involved with these cases. We are in the process of appealing all of them to show medical necessity.
 

LACLARK

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Having the same problems according to nosology there are no AMA guidelines for billing these yet, My Dr states these codes are for office use only, I elevated this to HIMS department they stated per AMA if balloon is used, we should be using Balloon codes.
 
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