Wiki CPT 2018 FESS codes clarification

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BarkerP

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I am a little confused on these new bundled codes. If my provider does work on all sinuses, do I use the new bundled codes (31253) total ethmoids and frontals and (31259) to account for the sphenoids? Seems like it's double dipping since (31259) also includes the ethmoids also.
 
I am glad I am not the only one confused by this. I have posed the same question to Karen Zupko. If I get a response from her I will share it here. I would assume that you can't get paid for a total ethmoidectomy twice. But I noticed that when I used find a code it allowed both of the codes (31253 and 31259) without an edit warning . Which I find highly unlikely. I am thinking that you could bill 31253 with either 31287 or 31288 depending on tissue removal in sphenoids or 31259 with 31276 since they also do not edit against each other.
 
jlmanning said:
I am glad I am not the only one confused by this. I have posed the same question to Karen Zupko. If I get a response from her I will share it here. I would assume that you can't get paid for a total ethmoidectomy twice. But I noticed that when I used find a code it allowed both of the codes (31253 and 31259) without an edit warning . Which I find highly unlikely. I am thinking that you could bill 31253 with either 31287 or 31288 depending on tissue removal in sphenoids or 31259 with 31276 since they also do not edit against each other.
Click to expand...

I was also surprised that I didn't find any sort of guidance from K. Zupko beforehand. I appreciate the feedback.
 
New Sinus Codes

I am in the same boat with y'all! Looking forward to feedback on this! Thanks!
 
New Sinus Codes

This is an answer from the coding forum for the AOA that I saw this morning:

Code the frontal sinuses independently, CPT 31276, which has an RVU of 10.85. Then use the combination code 31257 (total ethmoidectomy including sphenoidotomy) RVU 12.80 or 31259 (total ethmoidectomy including sphenoidotomy w/ tissue removal) RVU 13.57 for the other two sinuses.

This gives a total RVU of 23.65 (31276 + 31257) or 24.42 (31276 + 31259).

Since the frontal sinuses have the highest RVU of the three independent codes, keep that separate.
 
31298 2018 FESS codes

what would you do if the provider did a bilateral frontal and only a right side sphenoid?

the new codes are unilateral?

Thanks,
Janet
 
All three sinuses Frontal, total ethmoids and Sphenoids

Hi All. So glad to see that I'm not the only one confused by these new Endo codes. Could you please tell me how I should code when all three sinuses are done, Frontals, total ethmoids and sphenoids? Am I using 31253 (frontals and ethmoids) and a stand alone for the sphenoids (31288) or should I be repeating the ethmoids again with 31259? Or as mentioned below, since the frontals have a higher RVU, should I be doing 31276 and 31259? Thank you!!
 
New FESS coding

From AAPC: https://www.aapc.com/blog/40548-new-fess-codes-for-2018/

"FESS Question
The question is how will it be coded if all four sinuses are operated on the same side? The AMA should be issuing guidance for this via CPT® Assistant soon, but in the meantime, guidance from high ranking physicians of the AAO/HNS have indicated the following:

All 4 sinuses (with no removal of tissue) can be coded in one of two ways:

31253, 31287, 31256 or 31257, 31276, 31256

If tissue is removed, 31287 and/or 31256 would be replaced with 31288 and/or 31267 in the first coding combination or 31257 and/or 31256 would be replaced with 31259 and/or 31267."

_________

I personally would choose the second choice since the total RVUs are higher.

31253(9.00), 31287(3.5), 31256(3.11) <Total=15.61> or ***31257(8.00), 31276(6.75), 31256(3.11) <Total=17.86>
 
FESS codes are unilateral

ksamples said:
Hi Janet,

Did you get any response or answer to this question or can anyone offer some help?

Thanks,
KO<
Click to expand...

the FESS codes are unilateral and should be billed with a -50 modifier if bilateral. So if bilat Frontal + Rt Sphenoid then 31276-50 and 31287-RT (31288 if there was tissue removal)

It'll be trickier if there was an ethmoid done along with either the frontal or sphenoid. I suppose you can do a combo code for one side then code a separate code for the contralateral side.

So if bilat Frontal + Rt ethmoid then 31253-RT and 31276-LT.
 
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