Otolaryngology Coding Alert

Question:  My surgeon is getting information about the Propel sinus stent. If he offers the procedure, how would we bill for it? 

Texas Subscriber

Answer:  Your best option is to submit 31299 (Unlisted procedure, accessory sinuses) for the stent placement and let the facility bill for the stent itself. Be sure to include thorough documentation of your surgeon’s work and appropriate comparison information for his reimbursement.

Your doctor should be able to give you a good comparison code for the work involved in placing the Propel stent. It may be comparable to one of the epistaxis control codes, but ask your surgeon before reporting it this way. Make sure you include the medical benefits for using the Propel drug eluding stent in your cover letter for the unlisted code, such as the fact that the patient heals quicker and returns to work in a quicker time frame (which is of great value to employers who purchase insurance). The reimbursement assistance department from the company who sells Propel should have a list of their benefits for you to include in your letter.

More information: The physician usually places a Propel stent in the office, so include the cost of the item in the unlisted code. Put the NDC code for the Propel in Box 19 and indicate that it is for Propel. When setting your fee, providers might consider comparing the payment for in-office physician administered drugs, such as Botox to treat spasmodic dysphonia.  

Of the larger insurers, United and Cigna currently are paying 31299 for the procedure when you have thorough documentation. Aetna and some Blues are treating it as investigational. Because of this, get precertification for the procedure so your surgeon won’t  perform the service and not get reimbursed. Definitely contact the practice’s Propel representative for assistance as they have a CPC/CENTC in their reimbursement department.