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Otolaryngology Coding Alert

Use 61795 to Add $250+ to FESS Claim Under These Circumstances

5 answers ensure you report stereotactic guidance only when you should

If you appropriately bill stereotactic guidance in addition to sinus surgery, you can ethically boost the claim by more than $250. But before you bill 61795, make sure you know the facts about what codes it goes with, its multiple-procedure status, when stereotactic surgery is considered medically necessary, and the elements necessary for proper documentation. What Codes Can Take a 61795 Add-On? Code 61795 is an add-on code, meaning you must report it in addition to certain other codes. But identifying which codes you can add it on to may not be right at your fingertips. Usually, the CPT manual lists codes that the add-on code connects to, says Edwina Sprow, CPC, managing partner, Sprow Consulting Services, a division of AskLeslie.net, in Arizona and Texas. -But 61795 doesn-t.-

Answer: You can report planning for stereotactic guidance (+61795, Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [list separately in addition to code for primary procedure]) in addition to functional endoscopic sinus surgery (FESS) codes 31255-31288, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. The stereotaxis code includes:

- loading CT scans into a computer
- determining placement of sensors and coordinates
- measurement of the AP-PC line and angle calculations
- placement of the head frame, which you should not separately bill with 20660 (Application of cranial tongs, caliper, or stereotactic frame, including removal [separate procedure]).

Can I Always Report 61795 With 31255-31288? -Not every FESS requires 61795,- says Claudia Stephens, CPC, at ENT for Children PA in Coppell, Texas. If stereotactic guidance is the standard of care, bundling issues could occur. Insurers may question why 61795 should be separately payable.

Best practice: You should greenlight 61795 only when guidance is medically necessary. Insurance carriers have specific requirements for reimbursing sinus cases performed by this method, says Chasity Heisner, coder for Douglas W. Halliday, PhD, MD, PC, in Syracuse, N.Y. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) states that the documentation must include these indications for stereotactic use:

- disease abutting the skull base, orbit, optic nerve or carotid artery 
- cerebrospinal fluid rhinorrhea (349.81) or conditions where there is a skull-base defect
- benign (212.0) and malignant sino-nasal neoplasms 
- revision sinus surgery 
- distorted sinus anatomy of development, postoperative, or traumatic origin 
- extensive sino-nasal polyposis 
- pathology involving the complex posterior ethmoid, frontal and sphenoid sinuses. Fallback position: If your otolaryngologist wants to use stereotactic guidance more often than the above guidelines allow, give him the thumbs up. But charge 61795 only when the guidance meets medically necessity requirements, Cobuzzi says. Should I Appeal Denials for Justified 61795s? Generally, insurers will give you [...]


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