Otolaryngology Coding Alert

Identify differences between surgical techniques and coding considerations.

Across ENT practices nationwide, physicians are turning to sinus implants as an effective treatment option. The SINUVA™ and PROPEL™ sinus implants are becoming increasingly common physician tools to help expedite the healing process and avoid any unwanted complications.

But, as with all new and emerging medical technologies, coders may have a difficult time knowing when and how to report these services accurately in order to receive appropriate reimbursement.

Keep reading for all the information you’ll need to implement SINUVA™ and PROPEL™ sinus implants into your ENT practice.

Understand Surgical Technique, Context Behind Respective Sinus Implant

According to the product manufacturer’s website, www.sinuva.com, “SINUVA™ Sinus Implant is a corticosteroid-eluting (mometasone furoate) implant indicated for the treatment of nasal polyps in patients greater than or equal to 18 years of age who have had ethmoid sinus surgery.” Following ethmoid sinus surgery for nasal polyps, some providers might suggest SINUVA™ as an effective form of supplementary postsurgical treatment. Once administered into the polyp-filled sinus cavity, the SINUVA™ implant gradually delivers an anti-inflammatory medication over the course of a 90-day period. The provider will then remove the sinus implant on or before the 90-day period, depending on how the healing process unfolds.

The mechanism behind the PROPEL™ sinus implant is similar to that of SINUVA™, with a few key differences. According to their website for the PROPEL™ family of products, Intersect ENT describes PROPEL™ Sinus Implants as “the first of a new category of products offering localized, controlled drug delivery directly to the sinus tissue. The spring-like implant is inserted by a physician to maintain the surgical opening, prop open the ethmoid sinus, and gradually deliver an advanced corticosteroid (mometasone furoate) with anti-inflammatory properties directly to the sinus lining as the implant dissolves.” According to the Intersect ENT website, the PROPEL™ sinus implant comes in two additional forms:

• PROPEL™ Mini: A smaller version of the PROPEL™ Used to maintain the sinus opening after ethmoid or frontal sinus surgery.
• PROPEL™ Contour: Used to maintain the sinus opening after frontal or maxillary sinus surgery.

Typically, you’ll find that PROPEL™ is inserted at the time of surgery as an adjunct surgical supply, whereas SINUVA™ is inserted in the office setting after the patient has undergone a prior ethmoid sinus surgery. PROPEL™ insertions are usually administered in an outpatient facility or ambulatory surgical center (ASC).

Additionally, context is crucial when understanding when a provider makes the decision to utilize either service. In terms of billing for the sinus implantation services, payers may consider PROPEL™ implants as an inclusive component of the surgery they are accompanying. Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, AAPC Fellow, of CRN » » Healthcare in Tinton Falls, New Jersey advises that “providers should report the CPT^® code(s) which most accurately describes the services performed in association with placement of a drug-eluting sinus implant.”

Consider ICD-10-CM, HCPCS Code Submissions for SINUVA™

For SINUVA™, the coding process is relatively simple. Patients are eligible for SINUVA™ treatment as long as they are age 18 and above with a history of ethmoid sinus surgery. You must bill SINUVA™ administration along with one of the following nasal polyp ICD-10-CM codes:

• J33.0 — Polyp of nasal cavity
• J33.1 — Polypoid sinus degeneration
• J33.8 — Other polyp of sinus
• J33.9 — Nasal polyp, unspecified.

You will assign HCPCS code J3490 (Unclassified drugs) in addition to the underlying procedure code involving the placement of the SINUVA™ implant. Since the provider typically places the implant bilaterally, you should report J3490 with 2 units. Lastly, you will want to make sure to add the following National Drug Code (NDC) supplemental information in item 19 of the CMS1500 Claim Form:

• SINUVA™ (mometasone furoate) Sinus Implant, 1350 mcg. Intrasinal, NDC 10599000301.

Choose Between S1090, J3490 When Reporting PROPEL™

The coding process for each of the three PROPEL™ sinus implants is similar to SINUVA™. As is the case with the SINUVA™ implantation process, Cobuzzi explains that “when a (PROPEL™) implant is placed as an adjunct procedure, no additional codes should be reported to describe the work of implant placement.”

In terms of HCPCS code reporting, you will submit one of the following drug codes:

• S1090 — Mometasone furoate sinus implant,370 micrograms
• J3490.

According to the Intersect ENT website, you will report S1090 for “most commercial payers.” You will report J3490, on the other hand, when submitting to “Medicare contractors and some commercial payers.” When reporting code J3490, you will report one of the following three drug codes in item 19 of the CMS1500 Claim Form depending on which PROPEL™ sinus implant is used:

• 10599-0000-01, PROPEL™ (Mometasone furoate sinus implant, 370 micrograms)
• 10599-0001-01, PROPEL™ Mini (Mometasone furoate sinus implant, 370 micrograms)
• 10599-0002-01, PROPEL™ Contour (Mometasone furoate sinus implant, 370 microgram).

Finally, you will report a bilateral PROPEL™ implant insertion using two units, not with modifier 50 (Bilateral Procedure) or modifier LT (Left Side) and RT (Right Side).