Otolaryngology Coding Alert

You should use existing codes under these conditions, AAO-HNS says

The Academy has taken notice of the confusion surrounding coding for functional endoscopic sinus surgery (FESS) using balloon catheterization and ended the debate with an updated position policy.

In response to the December 2006 Otolaryngology Coding Alert article -Get the Inside Scoop on Balloon Sinuplasty Coding,- the AAO-HNS sent the editor the following revised position paper:

AAO-HNS Position on Coding for Sinus Balloon Catheterization (-Balloon Sinuplasty-)

-As more sinus procedures using balloon catheterization (-balloon sinuplasty-) have been performed over the last 18 months, there have been several publications giving advice on how to properly code the procedure. The AAO-HNS has been quoted in several of these and feels it is important to clarify our position in a single document. This statement will address only the actual coding issue rather than the indications or scientific merit of the technique.

-There is a significant difference in opinion among surgeons, insurance companies and coding specialists on the proper coding for the use of a sinus balloon catheter. One opinion states that current functional endoscopic sinus surgery (FESS) codes should not be used, but rather use CPT code 31299 (Unlisted procedure, accessory sinuses) because this is -new technology- with work that is dissimilar to the existing codes. Another opinion recommends the use of the current FESS codes since the work is similar, and balloon catheterization is simply another tool (such as using a microdebrider instead of forceps).

The AAO-HNS has had numerous discussions on this matter taking into consideration both the opinions and rationales associated with each side. First and foremost, we feel the physician should code for the work done based on the CPT descriptor for the code. When sinus endoscopy (with or without video) is used to create a sinusotomy in the frontal, maxillary or sphenoid sinuses whether using forceps, a microdebrider, a laser or a balloon catheter there is displacement of bone and mucosa. These various techniques have some variations in time among themselves and between operators, but we feel the work is similar enough to justify using existing codes when the following conditions are met:

1. A sinus endoscope is used to position the balloon prior to and during the cannulation of the ostia and confirming the dilatation with the balloon

2. Bone and mucosa must be moved in such a fashion to significantly enlarge the ostia of the sinus addressed.

-Since there is no removal of tissue, only CPT codes 31256 (Nasal/sinus endoscopy, surgical, with maxillary antrostomy), 31276 (Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus), and 31287 (Nasal/sinus endoscopy, surgical, with sphenoidotomy) should be used. Current usage would not justify the use of CPT codes 31254 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial [anterior]) or 31255 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) when doing balloon catheterization alone.-