Wiki Balloon sinuplasty-you use codes

[Lori Carroll]

Do you use codes 31256, 31276, and/or 31287 for balloon sinuplastys or do you use the unlisted procedure 31299. Acclarent is telling us that using the balloon is a technique and not a procedure so we would not use the unlisted procedure code. Thanks.

 

[juanitamendoza]

First you need to find out if the payer or carrier has any guidelines on what code to use (many do). If so, you should follow those guidelines. If not, this is what I've found:
1. CMS currently does not have a written directive on what CPT code to use for balloon sinuplasty.
2. There is not an industry standard on what CPT code to use.
3.AAO-HNS official position is that under specific circumstances certain current FESS codes can be used. See cohttp://www.entnet.org/Practice/Coding-for-Sinus-Balloon-Catheterization.cfm
4. If you are billing the facility component HCPCS code for cathether C1726. Medicare payment indicator for this is "N1" which means it's a packaged item, no separate payment made.
Hope this helps.

 

[cfellers]

Balloon Sinuplasty

First you need to find out if the payer or carrier has any guidelines on what code to use (many do). If so, you should follow those guidelines. If not, this is what I've found:
1. CMS currently does not have a written directive on what CPT code to use for balloon sinuplasty.
2. There is not an industry standard on what CPT code to use.
3.AAO-HNS official position is that under specific circumstances certain current FESS codes can be used. See cohttp://www.entnet.org/Practice/Coding-for-Sinus-Balloon-Catheterization.cfm
4. If you are billing the facility component HCPCS code for cathether C1726. Medicare payment indicator for this is "N1" which means it's a packaged item, no separate payment made.
Hope this helps.

My provider does several balloons in the office. Never use the unlisted procedure code. You need to check with each payer and how they want it billed.
BCBS of Iowa does not cover the Balloon procedure in the office, so the patient needs to go to the OR to have the procedure done. The provider needs to
dictate specifically that he gained access to x sinus by x . It will then bill paid.

 

[mjspidey]

We do several balloons in the office per week. The codes for a balloon sinuplasty are 31295, 31296,31297, and 31298.

 

[rytophmorg@yahoo.com]

I am having a hard time getting a 31296 and 31297 paid when billed together. The insurance co. will pay 31296 but not the 31297 stating bundle? We do these in the office. I am using modifiers of 50/51. Should I be using different modifiers? Thank you!