Wiki FESS coding

[nan.coder]

Good afternoon all. I'm still new to ENT and struggling with FESS coding.

Procedures performed: 1) Nasal endoscopy with frontal sinusotomy and tissue removal 2) Nasal endoscopy with total ethmoidectomy 3) nasal endoscopy with sphenoidotomy with tissue removal 4) nasal endoscopy with maxillary antrostomy and tissue removal 5) nasal endoscopy with polypectomy.

I'm pretty sure of CPT 31267 - nasal scope with maxillary antrostomy with tissue removal and 31253 - nasal scope with total ethmoidectomy , including frontal sinus exploration with removal of tissue.

What I'm not sure of is which of these code are more appropriate for this case.
1) CPT 31259 - nasal scope with total ethmoidectomy including spenoidotomy with tissue removal.
2) CPT 31288 - nasal scope with spenoidotomy with removal of tissue.

I'm leaning toward 31288 because total ethmoidectomy RVUs already captured with CPT 31253.

Any assistance would be greatly appreciated.

Nancy Boyle, CPC, CRC
Sound Health Services/Gateway Division
nboyle@soundhealthservices.com

 

[such78]

Good afternoon all. I'm still new to ENT and struggling with FESS coding.

Procedures performed: 1) Nasal endoscopy with frontal sinusotomy and tissue removal 2) Nasal endoscopy with total ethmoidectomy 3) nasal endoscopy with sphenoidotomy with tissue removal 4) nasal endoscopy with maxillary antrostomy and tissue removal 5) nasal endoscopy with polypectomy.

I'm pretty sure of CPT 31267 - nasal scope with maxillary antrostomy with tissue removal and 31253 - nasal scope with total ethmoidectomy , including frontal sinus exploration with removal of tissue.

What I'm not sure of is which of these code are more appropriate for this case.
1) CPT 31259 - nasal scope with total ethmoidectomy including spenoidotomy with tissue removal.
2) CPT 31288 - nasal scope with spenoidotomy with removal of tissue.

I'm leaning toward 31288 because total ethmoidectomy RVUs already captured with CPT 31253.

Any assistance would be greatly appreciated.

Nancy Boyle, CPC, CRC
Sound Health Services/Gateway Division
nboyle@soundhealthservices.com

When total ethmoidectomy and sphenoidotomy with removal of tissue are done on the same site, your code as 31259.
If total ethmoidectomy is done on left and sphenoidotomy with removal of tissue is done on right, your codes are 31255 -lt, 31288-rt. 31253 describes total ethmoidectomy is done with frontal sinus with tissue removal on the same site. When sphenoidotomy with tissue removal was done at the same encounter, you code as 31259 with total ethmoidectomy. Hopefully, it helps you understanding.

 

[b.cobuzzi]

Don't forget your 31276 for the frontal sinusotomy. Since you already bundled the total ethmoidectomy with the sphenoidotomy, you bill the frontal by itself. Also, billing the frontal by itself and bundling the sphenoids with the total ethmoid optimizes your RVUs. 31376 is not bundled in 31259 and you are allowed to bill for each sinus, but must bill for a bundled code if appropriate. Since a total ethmoidectomy bundles with multiple FESS codes, there is a chance that one of the codes will be billed as the unbundled code as you are seeing for this surgery, Nan.Coder.

Based on what you indicated, I see the surgery coded as:

31259 Total Ethmoidectomy with Sphenoidomy with tissue removal
31276 Frontal Sinustomy
31267 Maxillary Antrostomy with tissue removal

The nasal endoscopy with polypectomy is bundled with all of the above and not billed. If the polypectomy takes a significant amount of time and effort as reflected in the operative note, it is possible that a 22 modifier for increased service can be added to the 31259, but the added effort and time would have to be more than 25% more than what would take for a total ethmoidectomy and sphenoid with tissue removal. Then increase your fee by the % increase of work (effort and time) that the polypectomy took and indicate this in box 19 of your claim for example: "extensive polypectomy requiring extensive time and effort, increasing 31259 be additional 35%" This would take very good documentation by your physician.