Otolaryngology Coding Alert

Question: We received a denial when submitting 20985 with bilateral maxillary and frontal sinus balloon dilation procedures. Is there a modifier we should be submitting in order to get reimbursed for 20985?

Georgia Subscriber

Answer: When your functional endoscopic sinus surgery (FESS) is performed alongside a stereotactic computer-assisted (navigational) procedure, you should report add-on code +61782 (Stereotactic computer-assisted (navigational) procedure; cranial, extradural (List separately in addition to code for primary procedure)). CPT^® Assistant (July 2011; Volume 21: Issue 7) instructs that “the extradural cranial codes may be used for endoscopic sinus surgery, and for open and endoscopic skull base procedures.”

Furthermore, add-on code +20985 (Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (List separately in addition to code for primary procedure)) should not be considered since it is typically reserved for musculoskeletal procedures, such as joint replacement surgeries.

In reporting +61782 alongside 31295 (Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa) and 31296 (Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium) with modifier 50 (Bilateral procedure), you should confirm the operative report includes all the necessary criteria. CPT^® Assistant states that the documentation for code range 61781-61783 should include:

• “The physician work of image-based planning;
• “Description of the image acquisition;
• “Attachment of a reference frame;
• ““Registration and review of the image data sets; and
• “Verification of the accuracy.”