Otolaryngology Coding Alert

In response to questions and concerns regarding the December 2006 Otolaryngology Coding Alert (OTC) article on balloon sinuplasty technology, the editors are working with the Academy of Otolaryngology -- Head and Neck Surgery (AAO-HNS) and the device manufacturer, Acclarent Inc., to clarify which codes to bill when using balloon sinuplasty devices in endoscopic sinus surgery procedures.

The article implied that the technology may not be used with an endoscope. Acclarent indicates that the balloon sinuplasty devices are always used with an endoscope. And Acclarent has received written confirmation from many Medicare carriers and some private insurers that endoscopic sinus surgery procedures that involve balloon catheter devices should be coded with functional endoscopic sinus surgery (FESS) codes.

The Academy, however, confirms that FESS codes are only appropriate when the balloon is used in conjunction with the fundamental work involved in FESS, says Linda Taliaferro, health policy director at the AAO-HNS. When the balloon is used to do something different than that, such as to dilate a sinus, this scenario is best coded with an unlisted-procedure code.

The AAO-HNS is drafting a follow-up letter to OTC clarifying the Academy's current position. Taliaferro reviewed the OTC article and commented that while the Bulletin article cited is old (2005) and the Academy is still reviewing balloon sinuplasty, they still stand behind their Bulletin position as captured in the OTC article.

We hope this clears up some of the misunderstandings surrounding coding when using balloon sinuplasty. We regret that the article did not specify that Acclarent's Web site has not contained the coding recommendations cited in the article for over a year.