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Ballnuplastyon sinuplasty?

  1. #1
    Default Ballnuplastyon sinuplasty?
    Medical Coding Books
    Our ASC wants do these cases ballon sinuplasty ?Looking at diifrent forums in past , some say use unlisted codes , some say use reg sinus codes. Reps tell me to use reg sinus codes plus the C1726 for the balloon cathether. Which one if any are right ?, Help please, I need to figure this out before it gets to costly , or maybe NOT ?
    Last edited by codedog; 04-27-2010 at 03:08 PM. Reason: spell

  2. #2
    (These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

    This is what I posted yesterday:

    I am presently being cross-trained for ENT coding at my workplace (ASC billing company). Just today we went over nasal procedures where a balloon is used. We are directed to use the regular code and to add code S2344 - "Nasal/sinus endoscopy, surgical; with enlargement of sinus ostium opening using inflatable device (i.e., balloon sinuplasty)". Of course, do your own research, but this may be a good place to start.

    Here is new information today (still do research):

    Use code S2344 (only) when you are just doing the dilation with the balloon and no tissue is removed (but for Medicare use an unlisted code). If tissue is removed, just bill the regular code.

    So, tissue removal is the key.

    Richard Mann, your pain management coder
    Last edited by rkmcoder; 04-29-2010 at 10:17 AM.

  3. Default News Flash rec'd on 4/30/2010
    Balloon Sinus Dilation
    Coding Clarification

    CPT® codes 31256, 31276 and 31287 are not approved for coding balloon endoscopy when no tissue is removed according to a clarification recently issued by the American Medical Association (AMA). Instead, the AMA says the appropriate code for these procedures is 31299. Procedures coded with 31299 are not included on Medicare's ASC list. Therefore, ASCs that submit Medicare claims that include this code will not be reimbursed for these procedures.
    ASC billers should continue to use 31256, 31276 and 31287 for sinus endoscopy procedures in which a balloon is used endoscopically, along with cutting tools, to create a sinusotomy by removing tissue with the balloon dilation considered inclusive.

    The American Academy of Otolaryngology--Head and Neck Surgery (AAO-HNS) recently submitted three new codes to the AMA this past fall that would describe a stand-alone balloon procedure. According to the AAO-HNS, the AMA accepted these codes, and these codes are scheduled to be released for 2011.

    If this change is impacting your ASC's ability to bill for the balloon dilation procedures your ASC performs, we would like to hear from you. Please email with your ASC's name and estimated case volume for these procedures for 2010. We will use the information you provide as we work to ensure that these procedures are approved by Medicare for inclusion on the ASC list.

    ASC Association
    Last edited by Jamie Dezenzo; 05-03-2010 at 12:24 PM.

  4. #4
    Please share the source of this information.

    Richard Mann

  5. #5
    Thats fine , but we got an invioce for the balloon if cant bill for the balloon , then its not worth doing .I have to eat the cost ?
    Last edited by codedog; 05-04-2010 at 10:17 AM.

  6. Red face
    my asc has been undergoing many meetings with acclarent (the balloon rep) and many studies in regards to this exact situation.

    here is what we have found:

    The device is considered surgical equipment and cannot be billed separately by the asc.
    The device does not qualify as an implant as it is removed prior to the end of the surgery.
    The device adds anywhere from 1200-1800 dollars to your case cost
    The procedure can be billed with 31276 with commercial carriers, but why would you want to if you do not have a carve out for this particular procedure to cover the cost of this device? 31276 is a grouper 3 and typically has a low reimbursement of under 1000.00
    The procedure needs to be billed with 31299 for medicare, which currently will not reimburse this procedure at an asc as it is unlisted, only hospitals get paid for unlisted procedures.

    This is our outcome, because ENT cases can have a great reimbursement for multiple line items on a claim, and very little bundles, we have established that if all (bilat) sinuses are being treated during the same surgical session, bilat antrostomy, bilat tot ethmoidectomy, bilat turbinate resection, bilat sphenoidotomy and the bilat frontal sinuplasty then we would make enough to cover the case cost and the device -- barely

    Smiles to new technology --
    Caprice, CPC

  7. Default
    Our docs are wanting to do these cases also and we did check w/ our medical policy on one and it was not covered.

    Thanks for the info Caprice

  8. #8
    hmmmmmmmmm-, I told my supervisor this may not be cost efficent, hmmmmm, I dont thinkthis is good , not yeT anyway
    Last edited by codedog; 08-05-2010 at 07:38 AM.

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