CODING CORNER: Tackling Sinus Procedure Coding-Your Questions Answered

Expert tips for multiple and unlisted procedures

Multiple sinus procedures may be the the most difficult to report because you need to navigate confusing rules and may spend lots of time looking for a code that isn't there. Take these expert answers into account to streamline your next sinus search.
Add On Stereotaxis Code for Guidance
Question 1: Why is stereotaxis used in conjunction with sinus procedures, and how should I report it? Can I report it separately from the procedure?

Answer 1: Physicians use stereotactic guidance when performing certain sinus procedures - especially those in close proximity to the base of the skull - in order to prevent complications, such as cerebrospinal fluid (CSF) leaks, says George Alex, CPC, ACS-OR, with Iatro, a consulting firm in Baltimore, Md., that specializes in coding and reimbursement. The guidance allows them to know precisely where they are and precisely where their instruments are at any particular point in time. When doctors perform frontal ethmoidal or sphenoid work, they may end up using stereotaxis as part of it, Alex says.  
Yes, you can report stereotaxis (also known as computer assisted navigational imaging) separately from the other procedure. The appropriate code is add-on code 61795 (Stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [List separately in addition to code for primary procedure]), Alex says.
Hit the Mark With Unlisted Nose Code
Question 2: How would I code endoscopic septoplasty?
Answer 2: Because no specific code exists to describe endoscopic septoplasty, you should report unlisted code 30999 (Unlisted procedure, nose), says Lolita Jones, RHIA, CCS, an independent coding consultant who specializes in outpatient and ambulatory surgery center coding, billing, reimbursement, and operations in Fort Washington, Md.
The American Medical Association (AMA) came up with a guideline several years ago that says if a physician performs an endoscopic procedure, the first thing you should do is try to find a code in the endoscopic section for that particular procedure, Jones says.
If you do not find an endoscopic code, the AMA advises you to use an unlisted endoscopic procedure code, if it exists. If there is no unlisted endoscopic procedure code for that service, use the straight unlisted code for that particular anatomical site.

Smart idea: If you receive a written directive from the insurance company stating for you to use another code instead, be sure you have the directive on the insurer's letterhead and keep it on file, Jones says.
"This way, if there is ever any question in the future as to why you used another code, you have documentation showing that the insurance company told you to use [...]

- Published on 2005-08-12