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Otolaryngology Coding Alert

Obtain Reimbursement for Post-FESS Services

Persistence may be your strongest weapon in the battle for payment for post-sinus surgeries. Although services, such as debridements, performed after functional endoscopic sinus surgery (FESS) are separately payable according to HCFAs fee schedule, private carriers often deny these claims or follow guidelines that include a global period for FESS.

If FESS was performed during the same operative session as another procedure (e.g., septoplasty or turbinectomy) with a 90-day global period, obtaining payment for post-FESS services from local Medicare carriers may also be difficult: The carrier may incorrectly determine that the debridements are connected to the septoplasty and include them in that procedures global surgical package.

Coding Services Following FESS

After endoscopic sinus surgery, patients may require additional care, including debridement, control of epistaxis and E/M services.

For example, a 40-year-old female patient undergoes extensive sinus surgery involving the maxillary, ethmoid, sphenoid and frontal sinuses. No turbinate work or septoplasty is performed. The following day, the patient returns to the physicians office for an evaluation and removal of the packing. One week later, she again returns to the otolaryngologist, who finds extensive crusting requiring debridement in both ethmoid sinuses.

According to Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions in Lakewood, N.J., the original surgical session would be coded as follows:

31255-50 nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]; bilateral procedure (12.54 relative value units [RVUs] x 1.5);

31267 ... with removal of tissue from maxillary sinus (9.65 RVUs);

31276 ... with frontal sinus exploration, with or without removal of tissue from frontal sinus (15.11 RVUs); and

31288 ... with removal of tissue from the sphenoid sinus (8.28 RVUs).

According to HCFAs fee schedule, all four FESS procedures listed have zero global days. Therefore, any services performed thereafter should be separately payable by local Medicare carriers as well as by private payers who follow HCFA payment guidelines or use the relative value/resource-based schedule for reimbursement.

Accordingly, the next-day visit to evaluate the patient and remove the packing should be coded 9921x (established patient visit), depending on the level of E/M service (based on history, exam and medical decision-making) provided. No modifier is needed because the examination is not being performed during the global period of another procedure.

The debridement performed on the patient a week later is also separately payable and should be reported using 31237 (nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement [separate procedure]). Because the debridement is [...]