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MACs may be applying the multiple endoscopy rule incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple endoscopic procedures to the family of functional endoscopic sinus surgery (FESS) codes. Real-world Scenario Practices are now getting […]
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Consider anatomy and coding guidance to put things into perspective. Functional endoscopic sinus surgery (FESS) is a surgical procedure performed endoscopically on the nasal/sinus cavities. The purpose of the surgery is to reduce the symptoms of chronic sinusitis such as congestion, drainage, post-nasal drip, headaches, and facial pain. Coding FESS can be unnerving because there […]
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At a one month follow up appointment the provider performs the 31237, is this billable with a modifier or included in the surgery?
I’m finding conflicting information.
Thanks!
A lot of people have been asking questions about how to code FESS surgeries with the new combination codes when three or four sinuses are operated on. Sinus and FESS We have been expecting an AMA CPT® Assistant article with guidance this year, but no instructions have come from the AMA. I went to the […]
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here is part of the operative note- Now I would code this using the balloon codes- my understanding has always been- stating pathologic secretions removed is not enough for removal of actual tissues.
Attention was then directed to the maxillary sinus ostium. Beginning on the right side, the middle turbinate was medialized with a Freer elevator. The introducer catheter was next placed within the middle meatus under endoscopic guidance using a 0-degree endoscope. The curve tip of the introducer catheter was positioned within the inferior aspect of the ethmoidal infundibulum. A lighted guidewire was advanced through the introducer catheter and directed through the obstructed maxillary sinus ostium. The wire was coiled within the maxillary sinus. A balloon catheter was advanced over the guidewire. The balloon was positioned to span the maxillary ostium and then was inflated for a few seconds. Thereafter, the balloon, guidewire, and introducer were removed, and the maxillary sinus ostium was examined with an endoscope. The ostium was significantly enlarged and the preoperative obstruction had been relieved. A curved suction was placed through the dilated ostium, and pathologic secretions were removed. The same procedure was used on the opposite left side.
Attention was then directed to the frontal sinus/recess region. Beginning on the right side, the introducer catheter was carefully positioned in the ethmoidal pre-recess leading to the frontal sinus. The lighted guidewire was advanced and manipulated to advance through the frontal recess and enter the frontal sinus. The lighted wire was coiled within the sinus and visualized clearly in the forehead. The balloon catheter was then advanced over the wire to position the balloon within the frontal recess. The balloon was inflated, held for a few seconds, deflated, and then removed. Using an endoscope, the outflow track of the frontal sinus was examined. The track appeared to be significantly enlarged and the preoperative obstruction relieved. The same procedure was used on the opposite left side.
Please advise on how you would code this and what your opinion is of the balloon codes- Doc is stating we are giving an option to use either one. As said my understanding has always been if a balloon is used to inflate and no tissue is removed that the balloon code should be coded and not a regular FESS codes.
Any Help is greatly Appreciated!!!
2018 brings us new functional endoscopic sinus surgery codes (FESS) which bundle a total ethmoidectomy with both a frontal sinusotomy and a sphenoidotomy with and without removal of tissue. 2018 CPT® also provides a new bundled code for a frontal and sphenoid endoscopic balloon dilation. On initial review of these new codes and the instructions […]
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AAPC’s Knowledge Center welcomes Barbara Cobuzzi as a regular contributor. Nasal Sinus Endoscopy According to the American Rhinologic Society, several nasal sinus endoscopy services were identified as potentially misvalued because billing patterns revealed they were billed together more than 75 percent of the time (same beneficiary/same day of service). As a result, the specialty societies were […]
AAPC Knowledge Center
I have been given the ENT clinic as an auditing responsibility. Please help me understand if certain separate procedures are part of the global package. The patient had a Functional Endoscopic Sinus Surgery and presents 1 week postop. The physician performs a nasal endoscopy to help remove crusting from all patent sinuses. My feeling is that this procedure should be included during the postop period. The diagnosis used is nasal congestion.
This procedure 31231 and 92511 appear to be used quite frequently and would like to get a better handle on when this can be billed.
Please opine.
Thanks!