Tuesday, February 12, 2019

Functional Endoscopic Sinus Surgery

FESS.  Functional Endoscopic Sinus Surgery are procedures performed to open sinus cavities in order to promote airflow and drainage.  This inaugural installment of “Spotlight on CPT” looks at appropriate coding for FESS from a CPT perspective.

Properly coding outpatient endoscopic sinus surgery procedures begins with understanding the notes that pertain to those codes.   Some notes pertain to the entire sinus endoscopy section, while others are parenthetical notes that pertain to the specific code that they follow.  Many of the parenthetical notes dictate which, if any, other codes from the sinus endoscopy section can be coded in conjunction with the code the note follows.  As seen with all endoscopic type procedures, the initial section note instructs coders that a diagnostic endoscopy is included with a surgical sinus endoscopy and specific to surgical sinus procedures, sinusotomy is also included.  It is, however, permissible to assign a separate code for stereotactic computer-assisted navigation (61782) if it is performed in conjunction with an FESS procedure. 

Another note clarifies that all the codes in the range of 31233-31298 are considered unilateral unless noted otherwise.  Code 31231, which begins the FESS section, is unilateral or bilateral, which is important to note.  Additionally, the three diagnostic codes (31231-31235) include the inspection of all the following areas:
  • Interior of the nasal cavity 
  • Middle and superior meatus 
  • Turbinates 
  • Spheno-ethmoid recess

When one or more of the areas is not examined either because it is deemed not clinically necessary, altered anatomy precludes the inspection, or it is not technically feasible to perform the inspection, then a modifier should be added to indicate the reduction in service.  Modifier 52 is used if a repeat examination is not planned, or if a repeat examination will be done, then modifier 53 should be used.

In the 2018 CPT code updates, several combinations codes were introduced that combined a total ethmoidectomy procedure with frontal and sphenoid sinus procedures.  The key piece to assigning these codes correctly is that the ethmoidectomy must be a total procedure, meaning both anterior and posterior; otherwise, if only a partial ethmoidectomy is performed, two separate codes will be assigned; 31254 for the partial ethmoidectomy, and either 31276, 31287, or 31288 as appropriate for the other sinus procedures.

Another new combination code bundled frontal and sphenoid sinus ostial dilation (31298) when performed ipsilaterally.  Coders should take note that this code does not include maxillary sinus dilation (31295) thereby making it appropriate to assign the 31295 in addition to the 31298 if all three sinus ostia are dilated.

CPT Assistant clarification from February of 2016 indicates that packing used at the conclusion of an FESS procedure and any stent or implant placement is all considered part of the work incorporated with the FESS codes.  However, there are two drug-eluting implant codes specifically for the ethmoid sinus:

0406T Nasal endoscopy, surgical, ethmoid sinus, placement of drug-eluting implant

0407T Nasal endoscopy, surgical, ethmoid sinus, placement of drug-eluting implant with biopsy, polypectomy, or debridement

These are category III CPT codes which are temporary CPT codes and must be reported in lieu of an unlisted category I CPT code.   Unlisted code 31299 is to be used for placement of a drug-eluting implant in any sinus except the ethmoid.  The two temporary codes above may be assigned when the placement of the drug-eluting implant is a stand-alone procedure only.  Information provided in the notes precludes assignment of the implants with any other ipsilateral ethmoid procedure.

Now, light has been shed on FESS coding in CPT.

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

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