Anesthesia Coding Alert

Changing leaves may be a welcome relief from summer, but some less desirable aspects of fall - pollen, mold and mildew - can send allergy sufferers straight to their ENTs for endoscopic sinus surgeries. Use this expert advice to ensure that your surgeon's efforts to help patients shelve their tissues aren't the source of claims denials. Endoscopic Surgery Rescues Many Sinusitis Sufferers Endoscopic sinus surgery is a common procedure across the country. When performing endoscopic sinus surgery - also known as FESS, functional endoscopic sinus surgery - the physician inserts a fiberoptic telescope or endoscope through the nose to visualize the affected area. The surgeon can then correct a deviated septum, perform turbinate reduction/resection or remove polyps or cysts.
 
Many patients are searching for relief from chronic sinusitis, says Vicki Embich, anesthesia department coder at West Florida Medical Center Clinic in Pensacola. They might have had three or four serious sinus infections in six months," she says. Patients  may also have headaches, nosebleeds or other problems without associating them with sinus conditions. They might not realize the extent of their sinus problems until an x-ray shows the obstructions.
 
Physicians can diagnose patients who have endoscopic surgery to correct a deviated septum more easily. Most of these patients had an accident that caused a broken nose. If the break healed fairly well, the patient might postpone surgery until chronic problems - such as airway obstruction - leave no other option. Whatever the reason for surgery, keep the same considerations in mind when coding for anesthesia services. Watch Your Modifiers With 00160 Surgical codes for endoscopic sinus surgery include CPT 31231-CPT 31294 (various codes for diagnostic or surgical nasal/sinus endoscopy). These codes each cross to anesthesia code CPT 00160 (Anesthesia for procedures on nose and accessory sinuses; not otherwise specified), which is reported as five base units plus time. Only having one anesthesia code may seem like a coding cakewalk, but depending on the surgical codes the surgeon is reporting, your coding can become complicated - especially if the surgeon performs follow-up procedures.

For example, the surgeon may perform a subsequent diagnostic procedure (31231, Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) as a follow-up during the postoperative period. You can code the anesthesiologist's services with modifier -78 (Return to the operating room for a related procedure during the postoperative period) or modifier -79 (Unrelated procedure or service by the same physician during the postoperative period), depending on whether the subsequent procedure is related to the initial procedure.
 
"Being able to include modifiers depends on the documentation," says Samantha Mullins, CPC, an anesthesia coder with the physician group VitalMed Inc., [...]