FESS Procedures

karen1123

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When billing FESS procedures, are Stealth Guidance and insertion of Propel Stents billable procedures. If so, what CPT codes are appropriate?
 

ljones88

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FESS procedures

The 6 series codes for FESS surgeries are billable, assuming the documentation is there. If billing for the PROPEL in an office setting, the HCPCS code is S1090. If done in the facility, the provider wouldn't bill for the placement of PROPEL. Most payers are not paying on this code at this time. We have been paid by UHC so far but there is no guarantee that they wont request the money back. We are actually participating in a pilot study with Proponent to help facilitate establishment of a future RVU with CMS, but the leg work is long and approval may not come about for many years.

We often bill 61782 in the OR setting. Below is a sample of what some of our documentation shows to support 61782. It varies among different providers.

"After induction of anesthesia, the head frame or other hardware is affixed to the patient’s head taking care to precisely position the apparatus. Surface tracings of the head and facial regions are performed to register and calibrate the device. Verification of navigational accuracy is ascertained by correlating specific surface anatomic sites to the computer-generated images. Verification is repeated, after the nose has been topically decongested, by correlating intranasal anatomic sites visualized endoscopically.

Throughout the procedure, the operative field is visualized endoscopically, with frequent confirmation of position and relationship to surrounding vital instructions provided by placing a tracking device within the operative field, correlating the endoscopic view with the position indicated by the images on the computer monitor. Based on this information, intra-operative decisions are made to appropriately modify the approach and resection to help ensure a safe and effective surgical procedure."

Also what helps support the procedure the clinical support such as Clinical Example (61782):
"A 51 year old male presents with nasal polyposis and chronic sinusitis, which have failed medical management. A sinus CT shows significant disease involving multiple sinuses with distortion of normal anatomic landmarks. Endoscopic sinus surgery is planned with computer-assisted image-guided navigation."
 
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