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Need help with coding for Nasopharyngeal Balloon Sinuplasty

  1. Default Need help with coding for Nasopharyngeal Balloon Sinuplasty
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    I work for ENT physicians and this procedure is new to our practice. This patient has nasopharyngeal stenosis which is a rare condition. This 63 y/o male patient has nasal obstruction/congestion, surgical history of tonsillectomy and adenoidectomy as a child. Doctor wants to perform a nasopharyneal balloon sinuplasty. Doctor will also plan to do some releasing incisions to open the stenosis, then dilate and possibly place a stent while healing.

    Thanks for any help you can give.

    Maureen

  2. #2
    Default Balloon Dilation Nasopharynx
    I think, perhaps, like we are supposed to only code and bill the traditional FESS if a balloon dilation is performed AND some element of the traditional FESS is also done. For example, a frontal dilation is performed and the surgeon goes in endoscopically and removes some ostitic bone from the frontal sinus, we can't code 31296 for the balloon dilation. Once the scope and instruments are used and tissue is removed, we have to use the traditional FESS code,31276

    So, to your question, although the surgeon initially uses the balloon to dilate three Nasopharynx, he still has to use traditional dilation techniques.

    So there are two possibilities

    1/ bill the balloon dilation using unlisted code 31299 and equate it to 31295 for pricing and code the traditional dilation codes as well. The payer may not pay for all the dilation techniques used because what was discussed above. The more detailed the surgeon's documentation that supports the medical necessity for the multiple dilation techniques, the more ammunition you have to appeal to the payer and justify each code.

    2/ your other choice is to assume that the balloon dilation will be considered bundled ion the other dilations and just don't bill it.

    I like option 1 better

    Barbara J. Cobuzzi MBA, CPC, COC, CPC-P CPC-I CPCO, CENTC
    Consulting Editor Otolaryngology Coding Alert
    www.CRNHealthcare.com
    b.cobuzzi@att.net
    '
    Last edited by b.cobuzzi; 02-14-2019 at 10:06 AM.

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