Otolaryngology Coding Alert

Question: Will CMS start bundling 61795 into all endoscopic sinus surgery codes in April?

Louisiana Subscriber

Answer: No. The Correct Coding Initiative (CCI), version 14.1, is not planning to make stereotactic computer guidance (+61795, Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]) a component of functional endoscopic sinus surgery (FESS, 31255-31288) for physicians. The Academy of Otolaryngology -- Head and Neck Surgery has confirmed that no CCI edits are in effect for 61795. Further, Code Manager 2008 lists no such edits either for the first quarter of the year.

You may be incorrectly applying recent ambulatory surgical center (ASC) edits using the Outpatient Prospective Payment System (OPPS) to physician payments. The 2008 ASC fee schedule assigns 61795 a payment status indicator N1 (Packaged service/item; no separate payment made), which means planning for stereotactic computer guidance is always included in the facility base surgery and not separately payable. But physicians are paid using the 2008 Medicare physician fee schedule, which allows payment for 61795.

Bottom line: The 61795 package affects FESS for outpatient facility payment, not for physicians.

Example: An otolaryngologist uses stereotactic guidance in addition to a sphenoid frontal endoscopy involving an ASC patient who has chronic frontal and sphenoidal sinusitis. You should report 31276 (Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus), 61795 and 31287 (Nasal/sinus endoscopy, surgical, with sphenoidectomy).

Link 31276 with 473.1 (Chronic sinusitis; frontal), 31287 to 473.3 (- sphenoidal) and 61795 to both sinusitis diagnoses.

Code 61795 adds 6.55 transitional total relative value units to the procedure -- or about $250 (6.55 RVUs x 38.0870 conversion factor) to the surgery. But the facility cannot bill 61795 for the equipment.