Wiki Propel Stent

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suec

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Hello, Could someone clarify the coding for the propel stent S1091 for a hospital. If a FESS is done, total ethmoidectomy with frontal & sphenoidotomy with tissue removal and maxillary antrostomy with tissue removal. Also a septoplasty & turbinoplasty. Propel stents were placed in the ethmoid sinus cavity at the end of the procedure. Is the propel stent coded? My thinking is because a procedure was done in the ethmoids the propel stent placement is included in that FESS procedure. ( 31299 & S1091 is not coded) If only the propel stent was placed, coding would be 31299 & S1091. Correct? If the FESS was done in the maxillary sinus and the propel stent was placed in the ethmoid sinus then the coding would be 31299 & S1091. Correct? Does the payor matter? Am I missing any other codes for the propel stent? Thank you so much if someone could let me know if my thinking is correct!
 
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To report an endoscopic placement of a drug-eluting implant in the ethmoid sinus without any other nasal/sinus endoscopic surgical service, use 31299. Compare to Code 31231

To report an endoscopic placement of a drug-eluting implant in the ethmoid sinus in conjunction with biopsy, polypectomy, or debridement, use 31237

When placement of a drug-eluting sinus implant occurs as an adjunct procedure following an ethmoid or frontal sinus surgery procedure performed in the non-facility (i.e. physician office) setting, providers should continue to report the codes deemed appropriate by the provider for the procedure(s) performed. The work associated with implant placement is included in the work of sinus surgery procedure codes. Therefore, when an implant is placed as an adjunct procedure, no additional codes should be reported to describe the work of implant placement.
 
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simplyjoydavis@gmail.com said:
What about the HCPCS code for the implants? S1091-Stent, non-coronary, temporary, with delivery system (propel) or a C code like C2625-Stent, non-coronary, temporary, with delivery system?
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We do balloon sinuplasty in the office and use Propel implants.
It is billable to most insurance (HCPCS S1091). Medicare reimburses under a different HCPCS code
Just make sure if it requires prior auth, obtain one.
It's also best to make sure it is a covered benefit under the patients ins plan (specially for out of state BCBS policies).
We review insurance medical policy coverage for Propel, so we know if we are meeting guidelines
When billing, make sure you let the ins know the appropriate type of propel being used:
- Propel (for ethmoid sinus)
- Propel mini (for ethmoid sinus and frontal sinus opening)
- Propel contour ( for sinus ostia: frontal and maxillary)
 
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