Wiki New Balloon Sinuplasty Codes

[daknaack]

Hello!
I am wondering if anybody out there is using the new balloon sinuplasty codes---31295, 31296 and 31297?
I have been using these and am finding that most insurance companies consider these experimental and will not pay. My doctors and I are questioning if we should be using them, and I wonder when it is appropriate to utilize them? I have received all sorts of information, but I don't know what to believe at this point.
Any information that could be supplied would be appreciated.
Thank you!

 

[capricew]

Yes, our facility has been billing these new codes for the sinuplasty procedures with great success. We have not been denied at all, since using them as of january. The hardest part is getting our commercial payers to determine a fair and reasonable reimbursement since it is a new code.
If your doctor is performing this procedure with the balloon, then these are the correct codes to use. If you are having trouble getting them paid, then you need to continue your appeals process as it is not experimental. These are valid codes in the cpt book listed as category 1 codes.
Most payers will pay these codes as long as medicare pays them, which they do. Usually payers deny the category 2 or category 3 codes, not category 1 codes.

Hope this helps

 

[daknaack]

My thought on that was exactly what you are saying...these should not be experimental when they have actual codes for them. We are seeing that some insurance companies that had been paying them, are now starting (in May) to consider them experimental and won't be paying them. This is only recently becoming an issue for us. It has caused some questions as far as if I was using them correctly or not, but I believe I have been.

I appreciate your response.
Thank you!

 

[mburke81]

Baloon sinuplasty

I received denials for these new codes as well. We only use them if there is no tissue removed. Majority of the time my Docs remove tissuie from the sinus and bill the 31267 as we did in the past.