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Otolaryngology Coding Alert

Reader Questions:

Code OP-Report-Backed FESS Guidance

Published on Fri Jul 08, 2005

Question: May I bill separately for stereotactic guidance (such as with the CT Sinus InstaTrak) that the otolaryngologist uses during functional endoscopic sinus surgery (FESS)?


Mississippi Subscriber


Answer: You may report +61795 (Stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]) in addition to FESS in selected cases. The National Correct Coding Initiative, version 6.2, once made imaging guidance a component of FESS codes 31254-31256, 31267 and 31276. But a later NCCI version (7.0) eliminated these edits. Furthermore, the deletions are retroactive to the initial effective date of these edits (Aug. 15, 2000).

Nonetheless, you should reserve 61795 for complex sinus surgeries. The operative report's "findings" section should justify the use of stereotactic guidance by referring to prior surgery, opacification or extensive polyps, for example. In these cases, the image guidance is warranted to assist the surgeon in localizing anatomical structures and increasing patient safety, states the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS). Some examples in which the AAO-HNS indicates that image-guided sinus surgery may be appropriate include:
 

  • revision sinus surgery
     
  • distorted sinus anatomy of developmental, postoperative, disease or traumatic origin
     
  • extensive sino-nasal polyposis
     
  • pathology involving the frontal, posterior ethmoid, or sphenoid sinuses
     
  • disease abutting the skull base, orbit, optic nerve or carotid artery
     
  • cerebral spinal fluid (CSF) rhinorrhea or conditions in which a skull base defect exists
     
  • benign and malignant sino-nasal neoplasms.

    Beware: Some private payers are calling image guidance investigational or unproven and are denying payment. For instance, many Blue Cross Blue Shield carriers, such as BCBS of Illinois, consider image-guided sinus surgery investigational, and thus a noncovered service.

    If an insurer refuses to cover 61795 based on those grounds, warn patients that the carrier may deny payment. Have the patient sign a waiver stating that he will be responsible for payment in the event the insurer denies coverage.

    Also: Don't accept endoscopy-FESS edits. If payers consider 61795 a component of FESS codes 31254-31256, 31267 and 31276, enlist the AAO-HNS' help in fighting these inappropriate bundles.

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