I'm getting mixed ideas on this CPT code and wanted to see how other people are coding and billing these. Half of my physicians use 70486 and the other half use 77011. My understanding of 77011 is for imaging ti understand anatomic positioning and localization- which my physicians do the day before a procedure and charge for. If they do it during a procedure, it isn't billable as being used as surgical navigation. How do I tell that stereotactic guidance is being used in the report to code 77011? Here are two examples listed below- the first one was coded as 77011 and the second was coded as 70486.
1) Procedure: 0.4 mm CT imaging of the midface/paranasal sinuses obtained by the Landmarx imaging protocol
Diagnosis: chronic sinusitis.
Indications: has a history of previous endoscopic sinus surgery and continues to have recurring episodes of sinusitis with several courses of antibiotics failed. Endoscopic exam shows active infection.
Procedure Report: Moderately developed frontal sinuses bilaterally without mucoperiosteal thickening. Postoperative changes of the anterior ethmoid sinuses are present with no sign of active infection. Posterior ethmoid sinuses are normal. Sphenoid sinus is normal. Severe bilateral maxillary sinus mucosal thickening with patent ostiomeatal units. Partial inferior turbinectomy evident bilaterally.
Orbits: There is no obvious orbital pathology.
Assessment: Severe bilateral maxillary sinusitis with patent ostiomeatal units. Extensive postoperative changes. Frontal, ethmoid, and sphenoid sinuses are normal. (77011)
2) Procedure: 0.4 mm CT imaging of the midface/paranasal sinuses obtained by the Xoran MiniCat XCT
Diagnosis: Chronic rhinosinusitis.
Indications: has a history of chronic nasal airflow obstruction and previous sinonasal surgery. She has worsening symptoms of restricted nasal airflow and findings suspicious for possible nasal polyps and sinusitis. She has failed conservative therapy. An effort to determine the presence of chronic sinusitis as a driving cause of her chronic inflammatory nasal disease, CT imaging is indicated.
Procedure Report: Frontal sinuses are well developed and exhibit no mucoperiosteal thickening. Anterior ethmoid sinuses exhibit no mucosal disease. Sphenoid sinuses are normal. Maxillary sinuses exhibit no mucosal thickening. Osteomeatal units bilaterally obstructed by Haller cells with infundibular narrowing. Septum is deviated to the left. Middle turbinates are normal. Inferior turbinates are severely hypertrophic. Skull base is intact. Soft tissue and orbits are normal. No bony destruction present.
Orbits: There is no obvious orbital pathology.
Assessment: Significant left nasal septal deviation. Bilateral infundibular narrowing of the maxillary sinuses due to bilateral Haller cells. No active mucosal disease. (70486)
Any help or advice would be greatly appreciated!
1) Procedure: 0.4 mm CT imaging of the midface/paranasal sinuses obtained by the Landmarx imaging protocol
Diagnosis: chronic sinusitis.
Indications: has a history of previous endoscopic sinus surgery and continues to have recurring episodes of sinusitis with several courses of antibiotics failed. Endoscopic exam shows active infection.
Procedure Report: Moderately developed frontal sinuses bilaterally without mucoperiosteal thickening. Postoperative changes of the anterior ethmoid sinuses are present with no sign of active infection. Posterior ethmoid sinuses are normal. Sphenoid sinus is normal. Severe bilateral maxillary sinus mucosal thickening with patent ostiomeatal units. Partial inferior turbinectomy evident bilaterally.
Orbits: There is no obvious orbital pathology.
Assessment: Severe bilateral maxillary sinusitis with patent ostiomeatal units. Extensive postoperative changes. Frontal, ethmoid, and sphenoid sinuses are normal. (77011)
2) Procedure: 0.4 mm CT imaging of the midface/paranasal sinuses obtained by the Xoran MiniCat XCT
Diagnosis: Chronic rhinosinusitis.
Indications: has a history of chronic nasal airflow obstruction and previous sinonasal surgery. She has worsening symptoms of restricted nasal airflow and findings suspicious for possible nasal polyps and sinusitis. She has failed conservative therapy. An effort to determine the presence of chronic sinusitis as a driving cause of her chronic inflammatory nasal disease, CT imaging is indicated.
Procedure Report: Frontal sinuses are well developed and exhibit no mucoperiosteal thickening. Anterior ethmoid sinuses exhibit no mucosal disease. Sphenoid sinuses are normal. Maxillary sinuses exhibit no mucosal thickening. Osteomeatal units bilaterally obstructed by Haller cells with infundibular narrowing. Septum is deviated to the left. Middle turbinates are normal. Inferior turbinates are severely hypertrophic. Skull base is intact. Soft tissue and orbits are normal. No bony destruction present.
Orbits: There is no obvious orbital pathology.
Assessment: Significant left nasal septal deviation. Bilateral infundibular narrowing of the maxillary sinuses due to bilateral Haller cells. No active mucosal disease. (70486)
Any help or advice would be greatly appreciated!