Otolaryngology Coding Alert

This op report tests your sinus and turbinate coding skills You can unravel a tricky sinus procedure if you-re up to speed on this lingo and you know the related bundling and unbundling rules.

See if your turbinate coding is up to par by coding the following operative report:

The otolaryngologist began surgery using bipolar forceps to cauterize the inferior and medial borders of the inferior turbinate. He then gently in-fractured the middle turbinate and using the backbiting forceps amputated the inferior one-third of the uncinate process. He identified the natural ostium of the maxillary sinus and connected it with an accessory ostium that was inferior to it. It was extended posteriorly into the fontanel of the middle turbinate. The bulla ethmoidalis was exonerated using the Weil-Blakesley forceps. A Merocel nasal tampon was trimmed to an arrowhead shape and placed in the anterior middle meatus to prevent lateralization of the middle turbinate.

The otolaryngologist wants to charge for an:

- extramural cautery of the right inferior turbinate

- endoscopic right nasal antral window

- endoscopic right anterior ethmoidectomy. Encourage Using CPT Terms Coding the above op report is especially challenging, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. -It's hard to know exactly what the surgeon did because he uses terminology that we don't see in CPT.- For instance, it's not clear where he used the scope.

A major stumbling block is the description of -endoscopic right nasal antral window.- You have to do antrotomy (incision through the wall of an antrum) to make a nasal antral window, says John Fink, MD, an otolaryngologist at Dearborn Ear, Nose and Throat in Michigan.

Clearer way: Documentation for a nasal window usually describes -enlarging the antrotomy in all directions and talks about tucking flaps,- Fink says. But it is probably common to use the terms -nasal antral window- and -antrotomy- interchangeably.

Code it: The op report's listing of -endoscopic right nasal antral window- is really an antrostomy (the surgical formation of an opening into an antrum) of the maxillary sinus, Cobuzzi says. Report the procedure with 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy). Report Ethmoidectomy, Destruction You should code two additional procedures.

1. Ethmoidectomy: For the endoscopy of the right anterior ethmoid, assign 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior])

2. Destruction: Code the extramural cautery of the right inferior turbinate with 30802 (Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural). Include Excision With FESS

The otolaryngologist was correct not to list the excision of the middle turbinate as a reportable procedure. Although the op note says the otolaryngologist -in-fractured the middle turbinate- and -amputated the inferior one-third of the uncinate [...]