With eight sinuses, six turbinates and two separate nasal cavities to consider, coding for nasal and sinus endoscopies can be quite a complicated undertaking. Here are five tips to help you code your functional endoscopic sinus surgery (FESS) procedures accurately.
1. Computer-assisted surgery (CAS)
CPT code 61795 — “Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure)” — should be coded when computer-assisted endoscopies are performed. These instruments can be quite expensive, and although Medicare considers this code packaged into the code for the main procedure(s), commercial payors may reimburse separately for it. BrainLab, CBYON and InstaTrak are examples of instruments used for computer-assisted FESS.
2. Middle-turbinate surgery
Turbinate surgery codes 30130, 30140 and 30930 are specific to the inferior turbinates and should not be coded for procedures performed on the middle turbinates. The CPT manual instructs that you should code 30999 for resection and therapeutic fracture of the middle turbinate. However, there are two exceptions. According to the May 2003 CPT Assistant, when excision of the middle turbinate is performed with endoscopic ethmoidectomy and/or endoscopic polypectomy, it is considered included in these procedures and should not be separately reported.
3. Removal of sinus tissue
Review the note carefully to determine whether tissue is removed from the sinuses. More extensive codes (i.e. 31267 and 31288) can be assigned when tissue is removed from the maxillary and sphenoid sinuses. Check the note for references to removal of sinus lining, membrane, mucosa or polyps. Pus and secretions are not considered “tissue,” and drainage of such does not constitute removal of tissue.
4. Differentiate between 30130 and 30140
According to the May 2003 CPT Assistant, in order to code 30140, the surgeon must document that the mucosa was incised and, for the most part, preserved. The surgeon would remove submucosal turbinate bone through this incision. When radiofrequency (i.e. Coblation) is used to reduce the inferior turbinates, code 30802 — “Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; intramural” — should be assigned. Do not code 30140-52 for this procedure (CPT Assistant, March 2008).
5. Make sure the procedures are performed endoscopically
As simple as this tip may seem, I have audited quite a few cases in which the sinus procedures were performed via Caldwell-Luc antrotomies or frontal sinusotomies and not via endoscopy, yet the coder used the endoscopy codes for these. There are separate codes for non-endoscopic access to all sinuses (see the 310XX and 312XX series); familiarize yourself with these and use them when appropriate.
Note: CPT codes are copyright by the American Medical Association.
Mr. Rodriguez (denis.rodriguez@email. com) is a senior ASC coder and compliance auditor for The Coding Network, the country’s largest specialty-driven coding and auditing company. For more information, visit www.codingnetwork.com.