Clarifix cryoablation device - help on how to code

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Our physician performed a cryoablation of the nasal nerve for chronic rhinitis. There is some debate as to how to code. The physician feels 30117 and 31231 is appropriate but I feel it should be an unlisted code. I have provided part of the operative note below. Any thoughts on how this should be coded??

The left middle turbinate was medialized, and the treatment area at the point of attachment of the middle turbinate to the lateral wall was visualized. Under nasal endoscopy the cryoablation device previously prepped was advanced and placed on the mucosal surface overlying the Sphenopalatine Foramen located in the posterior aspect of the middle meatus, on the lateral nasal wall. The device was activated for 30 seconds to apply cryotherapy for destruction of the nasal nerves. Once the freezing stopped the patient was instructed to breathe through their nose to facilitate thawing of the frozen tissue. Once the device was determined to not be adherent to the mucosal surface, the probe was removed. After removing the cryoprobe the treated area was endoscopically inspected and a ~20 mm diameter blanched lesion indicating the destruction of the tissue was observed. Another freeze was performed using an identical technique immediately inferior to that just performed. This ensured that the dysfunctional nerve were adequately treated with cryoablation.
 

krstn1335

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Clarifix

I am currently having the same disagreement. A sales rep advised us that a consulting company is stating we should bill 30117 and 31231. I believe it should be an unlisted code! Cpt 30117 would be okay if this were cryoablation of an intra-nasal lesion. A nerve and a lesion are obviously not the same. I am interested if you have received any further information from any other sources on this matter.

Thank you,
Kristin
 
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Clarifix

We are having the same issue here! They (the reps) are also telling us to use a J -code for the device itself. The J-code they want us to use however, is for branchial thermoplasty. That uses heat not cryo! Any news?

Brian Smith CPC
 

dferrara

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We had the same concern and after speaking to their consulting group and the sales rep from Clarifix, our organization is going with the unlisted CPT code. CPT 30117 does not fit exactly what the Clarifix procedure does. The rep and consulting group even suggest that when authorizing this procedure that the insurance carrier might be consider not covered or "investigiational" since it's such a newer procedure.

It was also alarming that that sales rep and the consulting group also suggest to the provider that they can bill a 99214/24 after the procedure is performed, even though the symptoms the patient might be experience is due to the procedure and it should be part of the global period...
 

b.cobuzzi

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Clarifix

Actually, the procedure was evaluated by physicians who serve in the CPT editorial committee from three AAO/HNS. They felt that the destruction of the nerve ending read equivalent to the destruction of a lesion and they agree that 30117 is the appropriate code to use. That is why Arrinex is recommending using 30117

Email me if you have any further questions
b. cobuzzi@att.net

Barbara J. Cobuzzi MBA, CPC, COC, CPC-P, CPC-I, CPCO, CENTC
Consulting Editor of Otolaryngology Coding Alert
www.CRNHEALTHCARE.com
 
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Cape Coral, FL
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Barbara,

Thanks for responding to my question regarding this procedure and just wanted to ask if there was an article somewhere? We are still having this discussion in the office. Insurance has paid the unlisted code after documentation has gone into medical review. I see a lesion being as a pathologically altered tissue or result of an injury or wound. I just wanted to see if there was a bit more information out there so we can understand.

Thanks,
Diana
 

sbuck328

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Clarifix

Actually, the procedure was evaluated by physicians who serve in the CPT editorial committee from three AAO/HNS. They felt that the destruction of the nerve ending read equivalent to the destruction of a lesion and they agree that 30117 is the appropriate code to use. That is why Arrinex is recommending using 30117

Email me if you have any further questions
b. cobuzzi@att.net

Barbara J. Cobuzzi MBA, CPC, COC, CPC-P, CPC-I, CPCO, CENTC
Consulting Editor of Otolaryngology Coding Alert
www.CRNHEALTHCARE.com
Hi Barbara,
Would this still be the correct code if procedure was performed with an endoscope?
Thank you
 

b.cobuzzi

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Yes, use 30117 for Clarifix. You cannot bill the 31231 because 31231 is a separate procedure, meaning you cannot bill it with anything else being performed in the same anatomic area.

30117 cannot be billed bilaterally, you need to use the XS modifier on a second line for payers that recognize the X[ESPU] modifiers. Use a 59 for payers who do not recognize the X[ESPU] modifiers. You want to minimize your 59 usage and use X[ESPU] as much as possible for distinct procedural services to show payers that you know what you are doing and are not just unbundling to get paid.
 

b.cobuzzi

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As far as I know, there is no article from the AAO. But you can contact Stryker directly (Stryker owns Clarifix) and they can supply you with coding and reimbursement guidance for Clarifix. You should email Betsy Towah and you can reach her at ENT-Reimbursement@stryker.com Also Betsy wanted me to let all of you know that they have an Unlisted Billing Guide for Clarifix.

Although I know that verbal ok was given to the original owners of Clarifix to code 30117, before Stryker acquired the company, there has yet to be anything that has come out in writing that says 30117 can be used for the procedure. So, Stryker is now taking the position to bill unlisted code 30999. Reach out to Betsy at the above email address and she will send you their billing guide for Clarifix.
 
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CROBINSON1988

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I do not believe the cryoablation should be coded with 30117. There has been nothing in writing from the AAOHNS, stating to code it with 30117. In fact, you would be putting the company at a risk for auditing if/when the payers catch on wand realize that lesions arent being ablated. Some payers have specific policies that do NOT cover cryoablation for rhinitis, and those should be self pay. As coders we are obligated and legally bound to follow CPT guidelines.
 

b.cobuzzi

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As far as I know, there is no article from the AAO. But you can contact Stryker directly (Stryker owns Clarifix) and they can supply you with coding and reimbursement guidance for Clarifix. You should email Betsy Towah and you can reach her at ENT-Reimbursement@stryker.com Also Betsy wanted me to let all of you know that they have an Unlisted Billing Guide for Clarifix.

Although I know that verbal ok was given to the original owners of Clarifix to code 30117, before Stryker acquired the company, there has yet to be anything that has come out in writing that says 30117 can be used for the procedure. So, Stryker is now taking the position to bill unlisted code 30999. Reach out to Betsy at the above email address and she will send you their billing guide for Clarifix.
 

b.cobuzzi

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I misunderstood the email sent to me by Betsy from Stryker when she asked me to post that she would provide an Unlisted Billing Guide. This has been clarified to me from the Reimbursement Department at Stryker as follows:

“Stryker’s position has never changed and we recommend billing ClariFIx with the 30117 or the unlisted code 30999 until there is further formal guidance from AAO“
 
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Just as a reminder, as the provider, it is ultimately your responsibility for selecting appropriate codes, documenting the procedures, and submitting claims consistent with the payor’s requirements for the performed procedure, considering all the circumstances presented by each patient's treatment.

Please feel free to reach out to our Hotline if you have any other questions.

Email: ENT-Reimbursement@stryker.com

Thank you! :)
 
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