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The multiple surgery calculation for nasal endoscopy codes is changed when multiple nasal endoscopies are performed in the same session on the same day. For Calendar Year 2020, instead of paying the multiple surgeries at 50 percent, surgeons will be paid the difference between the fee for the procedure performed and the base code for […]
The post Special Rules Apply to Endoscopic Sinus Surgeries appeared first on AAPC Knowledge Center.
The Centers for Medicare & Medicaid Services (CMS) is proposing major payment changes to sinus endoscopy services. The 2020 Physician Fee Schedule (PFS) proposed rule includes the following excerpt: We are proposing to apply the special rule for multiple endoscopic procedures to this family of codes beginning in CY 2020. This proposal would treat this […]
The post CMS Proposes Payment Changes to Endoscopic Sinus Codes appeared first on AAPC Knowledge Center.
An auditor asked the question of postoperative sinus debridements while discussing functional endoscopic sinus surgery (FESS). It was asked if postoperative debridements are coded and chargeable when a septoplasty or a turbinate procedure is performed. Auditing Zero Global Days The reason the auditor qualified the question as a FESS surgery performed with a septoplasty or […]
The post Auditing Postoperative Sinus Debridements appeared first on AAPC Knowledge Center.
The nurse is asking me what an appropriate CPT would be for "excision of left helical sinus and tract (which is actually the ear), would it be 69110?"
I am not sure CPT 69110 is specific enough but I cannot find any CPT code that seems to cover what they are doing. Plus honestly, I can’t even find what the helical sinus and tract even is.
I did keep coming across information stating to use the Benign excision codes 1144x. Which is what I am leaning towards but I am not sure that is correct.
I am at a loss with this, and would greatly appreciate some help with a CPT for this.
TIA
KM CPC
I have found the below documentation from the 2010 ICD-9 Coding Clinic that states if a pacemaker is placed to treat the sick sinus syndrome, that only the pacemaker code should be used. I am not able to find any documentation that shows this has changed. Would this only occur during the interrogation? Would you be able to bill both codes out at a regular follow-up visit?
Would a complete heart block fall into the same situation? I am not able to find any official documentation to confirm if the complete heart block and pacemaker codes can be used together.
Not billing the complete heart block would affect the patient’s risk score just as with the sick sinus syndrome.
Any and all help is greatly appreciated!
Thank you – Missy
ICD-9-CM Coding Clinic, Third Quarter 2010 Pages: 9-10 Effective with discharges: October 1, 2010
Question:
Coding Clinic, Fifth Issue 1993, page 12, advised that when sick sinus syndrome (SSS) is controlled by a pacemaker, no code assignment is required if no attention or treatment is provided to the condition or the device. However, we are seeing records where the patient is admitted for an unrelated condition, but during the stay the physician does an interrogation of the pacemaker. Is it appropriate to assign a code for sick sinus syndrome, as a chronic condition, when a patient has a previously placed pacemaker and it is interrogated during the hospitalization?
Answer:
Assign code V53.31, Fitting and adjustment of other device, Cardiac device, cardiac pacemaker, as an additional code assignment. A code is not assigned for sick sinus syndrome when it is being controlled by the pacemaker and no problems are detected during the check. Interrogation is a routine check, which is done via computer to assess pacemaker function. The pacemaker is routinely evaluated to ensure the device is programmed accurately as well as to assess battery and lead function. Pacemaker settings may be reprogrammed, if required. Interrogation of the device can be done in the inpatient setting or in the office setting.
Code 89.45, Artificial pacemaker rate check, may be assigned for the procedure.
Thanks in advance
becky hutchens
Indications: Chronic presacral sinus secondary to anastomotic leak.
Description of Procedure: The patient was brought to the abdomen placed on the operative table in supine position. After administration of adequate anesthesia the patient was placed in lithotomy position. The patient was prepped and draped in usual sterile fashion. Timeout was performed. The patient received preoperative antibiotics in the form of Flagyl. The perianal area was injected with 30 mL of 1% lidocaine with epinephrine and 0.5% Marcaine mixed. Digital rectal examination revealed the drain was in a posterior presacral cavity. Perianal examination revealed no masses. No fistula or fissure. Digital rectal examination did not reveal any clear mass. The rectum proximal to the area of the posterior sinus was collapsed and scarred down. The drain was then removed in its entirety. The area of the posterior sinus was then probed. Passage of the new catheter which was a 12 French mushroom catheter was very difficult. Because of the angulation and granulation tissue present was difficult to advance the catheter. Approximately 1 hour was spent attempting to do this. Finally the area of the sinus was debrided bluntly and sharply. Granulation tissue was evacuated. A flexible sigmoidoscopy was performed up to the level of the collapsed rectum. There was no signs of mass. Biopsies were taken. Colonoscope was removed. The 12 French mushroom drain was then placed within the cavity. It appeared to stay in place. It was then secured to the left buttock with a 0 silk stitch. The perianal area was then cleaned dried and dressings applied. The patient was then awakened from anesthesia in stable condition.
Sinus surgeries are more for chronic cases whereby the standard prescription medicines do not work anymore. It is also for those suffering from recurrent sinusitis. Sinus surgery is usually recommended only as a last resort. Acute sinusitis and chronic sinusitis are often treated with antibiotics, antihistamines, decongestants and mucolytics ( prescribed for thinning the mucus). Sometimes pain-relief drugs may also be prescribed for those those experiencing severe sinus infection symptoms such as sinus headaches in the frontal sinuses and ethmoid sinuses.
Simple home remedies for sinus infection like steam inhalation and flushing the nasal passages with saline water (nasal irrigation) can help ease these symptoms. Nasal irrigation can be administered by using a plastic syringe or a neti pot. Some clinics provide a more thorough nasal cleansing system of the sinuses. This is called the entral wash whereby a tube is inserted into the patient’s nostrils to flush it out with saline solution.
Functional Endoscopic Sinus Surgery
For many patients who suffer from severe and recurring sinusitis, there is a more permanent solution. This is medically called functional endoscopic sinus surgery (fess). This operation involves the removal of inflamed and infected tissues. It could also be adopted for expanding the sinus passages so as to achieve better drainage.
Image guided surgery was originally developed for neurosurgery but was subsequently adopted in endoscopic sinus surgery. This surgery combines CT Scans and real time information of the exact position of the instruments. This is done through three dimensional mapping.
This minimally-invasive operation is done completely through the nostrils without any external incisions and a new technology known as Image Guided Systems (IGS) have allowed ENT specialists to more accurately locate the affected sinus areas which require surgery.
This revolutionary method focuses on resolving the underlying cause of the problem. During surgery, the damaged tissues that causes swelling in the mucosa are removed. There is only minor discomfort felt after the procedure. There is also the advantage of having no scarring or swelling.
The use of such technology has the advantage of reducing the chances of complications during surgery. For those with facial deformities, IGS has proven to be invaluable. Most patients will recover within a week to 10 days after the FESS procedure which is often done as a day surgery.
Do you know that 90% of sinus infections are caused by 3 major factors? Look out for the telling signs and sinus infection symptoms and how easily you can solve and prevent them at Sinus Infection Help