# 31296 vs 31276 place of service?



## nparmele (Sep 16, 2013)

Can 31296 be used in an OR setting of hospital on an outpatient?  If place of service makes a difference between using 31276 vs 31296 for the exact same procedure, can someone please send me where on CMS web site it states this?
I am being told that if the balloon is used in the OR of a hospital (which is not an office, clinic or asc) then 31276 is to be coded as 31276 states any method to open the sinus up and balloon counts as "any".
Or is it the "exploration"?  Once the exploration is turned in to a "dilation or displacement" that turns it from the 76 to the 96?
I have the print out from American Academy of Otolaryngology-Head and Neck Surgery but it does not clarify an OR setting.
Payment isn't my issue...Correct coding is.  Am I compeletely off base?


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## Candice_Fenildo (Sep 16, 2013)

Ok.. Here goes. 

CPT Codes 31295-31297 are for coding Sinus Endoscopy with Balloon Dilation. Whether it is in an OR setting or Clinic Surgical Suite setting. Same CPT codes apply. 

The only time you would revert back to the traditional FEES codes 31267, 31276, 31288 is if any TISSUE is removed from the Sinus Ostia during the procedure. 

So lets say that "JACK" went in for a maxillary antrostomy with tissue removal and Dr. Nose dictated that he performed an endoscopic maxillary antrostomy utilizing the Medtronic Balloon Dilation System. you would still code the Hybrid FEES codes. .

Now... If Jack goes in for surgery and Dr. Nose dictates that he performed an endoscopic maxillary antrostomy using the balloon dilation system and that the maxillary Ostia was dilated to 8mm and released to establish an opening and does not mention ANY tissue removal, then you would code the PURE balloon code 31295.

Make Sense? 
Hope this helps, if not feel free to reach out and I can assist you further


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## Candice_Fenildo (Sep 16, 2013)

And when they say tissue removal it must be.. Tissue: polyps, mucocele, fungus, cyst 

NOT debris or mucous


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## nparmele (Sep 18, 2013)

Hi Candice,
Thank you so much for answering me.  It sounds like I am on the same page as you.  Do you have any documentation (web site info, coding book info) that I can use to support this?  Something that I can show to the doctor?  If you have the time I'm pasting the op note that I am specifically referring to with the codes the doctor gave.  DX was chronic sinusitis in frontal and ethmoid. No tissue taken from frontal, only ethmoid.  Thank you!!!!  



PROCEDURE PERFORMED:
1.  Bilateral endoscopic sinus surgery including right and left
anterior-posterior ethmoidectomy, CPT code 31255.
2.  Right and left frontal sinusotomy (balloon technique), CPT code
31276.

(anesthesia)...ethmoid sinus on both sides.  We first addressed the left sinus system.
With direct endoscopic visualization, the balloon dilatation system was
introduced under the head of left middle turbinate.  A guidewire was
advanced into the left frontal sinus and positioning was confirmed with
transillumination.  Then, the 6 x 16 mm dilatation catheter was
advanced over the guidewire to serially dilate the frontoethmoid tract.
This was done in three stages, each time inflating the balloon to 12
atmospheres of pressure.  Next, the anterior ethmoid was opened at the
bulla using Blakesley forceps.  Ethmoid cavity was developed from
anterior to posterior with care to preserve the lamina paprycea and
fovea ethmoidalis.  Polypoid mucosal disease was found all throughout
the ethmoid sinus.  The specimen was sent for routine pathologic
review.  Attention was then directed to the right nasal passage.  The
0-degree endoscope was introduced and balloon dilatation system was
introduced under the head of the middle turbinate.  Guidewire was
passed several times in an attempt to find the native frontoethmoid
tract but initially this could not be accomplished.  Inspection of the
region did reveal some buildup of polypoid tissue superiorly at the
region approximately where the frontal access would be expected.  This
polypoid tissue was removed with upbiting Blakesley forceps.
Ethmoidectomy was initiated at the ethmoid bulla using Blakesley
forceps.  Polypoid tissues were removed and the dissection was
continued from anterior to posterior along the ethmoid cavity.  Care
was taken to preserve the lamina paprycea and fovea ethmoidalis.  On
both sides, the cavity was enlarged and made smoother using the
microdebrider system fitted with 4 mm Tricut blade and operated at 3000
RPM.  I again introduced the balloon dilatation system at the right
middle meatus and did succeed to pass the illuminated guidewire into
the right frontal sinus.  This was confirmed by transillumination.  The
frontoethmoid tract was then dilated serially using the 6 x 16 mm
dilatation catheter each time inflating to 12 atmospheres pressure.
The wounds were irrigated with saline and reinspected to assure there
was satisfactory hemostasis.  There was minor bloody ooze on both.....(surgery ended)


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