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getting paid in full with balloon sinus ?

  1. #1
    Default getting paid in full with balloon sinus ?
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    I know they had an article while back stating to use regular sinus codes for the balloon sinus surgery and not to use the unlisted code for ASC . Now what about the cost for the procedure , is threre a special L code that you can bill addition with or do you eat the cost ? help-
    and did anyone hear if there will be 2011 codes for sure for the balloon.
    anybody please respond ,

  2. Default
    You may already know this - but you can still use the regular ESS codes if tissue was removed before or after the balloon was used. (Check out AAO website - American Academy of Otolaryngology - click on Practice and Advocacy - then click on 'Coding Resources' - then click on 'CPT for ENT') The 31299 still needs to be used if all they did was dilate with the balloon, though. According to the AAO, there WILL be new CPT codes for the sinus ostial dilation in 2011. But knowing how fast CPT and AMA works, who knows if we'll see those for 2011. But AAO is a powerful organization, advocacy-wise, so maybe they will help it happen. I'm sure the American Rhinolgic Society is also pushing for these. I haven't gotten paid on any of my 31299's yet - still in medical review with the payers.

    Our ENT surgeons do these, which is a challenge to people like me who figure out and obsess over net revenues per case, ROA, ROE, etc. for the business. We can't charge anything additional for the balloon supply/equipment expenses to our payers because these weren't indicated in carve-outs in the contracts.... we have to negotiate them as carve outs so we can bill extra for them. Costs were figured into the 31299 charges but none of these have been paid yet.

    If anyone out there knows more, please share.

  3. #3
    THANKS, seems like everone has the same problem.

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