niekjevanhoof
New
I have been in battle with one of our ENT doctor's regarding his FESS cases- would really like to get some other coder's opinion on this. (for Hospital case)
here is part of the operative note- Now I would code this using the balloon codes- my understanding has always been- stating pathologic secretions removed is not enough for removal of actual tissues.
Attention was then directed to the maxillary sinus ostium. Beginning on the right side, the middle turbinate was medialized with a Freer elevator. The introducer catheter was next placed within the middle meatus under endoscopic guidance using a 0-degree endoscope. The curve tip of the introducer catheter was positioned within the inferior aspect of the ethmoidal infundibulum. A lighted guidewire was advanced through the introducer catheter and directed through the obstructed maxillary sinus ostium. The wire was coiled within the maxillary sinus. A balloon catheter was advanced over the guidewire. The balloon was positioned to span the maxillary ostium and then was inflated for a few seconds. Thereafter, the balloon, guidewire, and introducer were removed, and the maxillary sinus ostium was examined with an endoscope. The ostium was significantly enlarged and the preoperative obstruction had been relieved. A curved suction was placed through the dilated ostium, and pathologic secretions were removed. The same procedure was used on the opposite left side.
Attention was then directed to the frontal sinus/recess region. Beginning on the right side, the introducer catheter was carefully positioned in the ethmoidal pre-recess leading to the frontal sinus. The lighted guidewire was advanced and manipulated to advance through the frontal recess and enter the frontal sinus. The lighted wire was coiled within the sinus and visualized clearly in the forehead. The balloon catheter was then advanced over the wire to position the balloon within the frontal recess. The balloon was inflated, held for a few seconds, deflated, and then removed. Using an endoscope, the outflow track of the frontal sinus was examined. The track appeared to be significantly enlarged and the preoperative obstruction relieved. The same procedure was used on the opposite left side.
Please advise on how you would code this and what your opinion is of the balloon codes- Doc is stating we are giving an option to use either one. As said my understanding has always been if a balloon is used to inflate and no tissue is removed that the balloon code should be coded and not a regular FESS codes.
Any Help is greatly Appreciated!!!
here is part of the operative note- Now I would code this using the balloon codes- my understanding has always been- stating pathologic secretions removed is not enough for removal of actual tissues.
Attention was then directed to the maxillary sinus ostium. Beginning on the right side, the middle turbinate was medialized with a Freer elevator. The introducer catheter was next placed within the middle meatus under endoscopic guidance using a 0-degree endoscope. The curve tip of the introducer catheter was positioned within the inferior aspect of the ethmoidal infundibulum. A lighted guidewire was advanced through the introducer catheter and directed through the obstructed maxillary sinus ostium. The wire was coiled within the maxillary sinus. A balloon catheter was advanced over the guidewire. The balloon was positioned to span the maxillary ostium and then was inflated for a few seconds. Thereafter, the balloon, guidewire, and introducer were removed, and the maxillary sinus ostium was examined with an endoscope. The ostium was significantly enlarged and the preoperative obstruction had been relieved. A curved suction was placed through the dilated ostium, and pathologic secretions were removed. The same procedure was used on the opposite left side.
Attention was then directed to the frontal sinus/recess region. Beginning on the right side, the introducer catheter was carefully positioned in the ethmoidal pre-recess leading to the frontal sinus. The lighted guidewire was advanced and manipulated to advance through the frontal recess and enter the frontal sinus. The lighted wire was coiled within the sinus and visualized clearly in the forehead. The balloon catheter was then advanced over the wire to position the balloon within the frontal recess. The balloon was inflated, held for a few seconds, deflated, and then removed. Using an endoscope, the outflow track of the frontal sinus was examined. The track appeared to be significantly enlarged and the preoperative obstruction relieved. The same procedure was used on the opposite left side.
Please advise on how you would code this and what your opinion is of the balloon codes- Doc is stating we are giving an option to use either one. As said my understanding has always been if a balloon is used to inflate and no tissue is removed that the balloon code should be coded and not a regular FESS codes.
Any Help is greatly Appreciated!!!