Otolaryngology Coding Alert

Check whether you can report these sinus implants.

CPT® already includes a fair number of codes for sinus endoscopy, but 2016 brings you two more choices:

• 0406T – Nasal endoscopy, surgical, ethmoid sinus; placement of drug eluting implant
• 0407T -- … with biopsy, polypectomy or debridement.

These codes address the use of PROPEL drug-eluting sinus implants, specifically when the implants are placed in a separate encounter, not at the time of endoscopic sinus surgery. Therefore, guidelines with the codes instruct that you should not report either 0406T or 0407T with numerous other sinus procedures when the surgeon performs the procedures on the same side.

You also will not be able to report 0407T in conjunction with 0406T when the procedures are performed on the same side during the same encounter.

Remember: CPT® Category III codes are temporary codes for emerging technologies, procedures, and services. They are intended to be used for data collection to substantiate widespread usage and to determine if the code should shift to Category I status at some point. Payment for these services or procedures is based on payer policy and not on a yearly fee schedule. You should submit what you feel is a fair payment for the Category III codes, similar to how you provide equitable services when the 22 modifier for increased services is used or an unlisted procedure is used.