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News -> January, 2004 News
Jordan Josephson, M.D.
Functional Endoscopic Sinus Surgery (FESS) has been a great advance in medicine. Three reasons for this include: more accurate diagnosis of sinus disease, FESS techniques in the operating room, and most importantly a means to provide meticulous post-operative care in the immediate post-op period (30-60 days) and to control long term chronic disease, affording patients a better quality of life.
Recently a study was done stating debridements were performed an average of 1.2 times after FESS. This is misleading because it includes input from the greater than 50% of physicians that do not perform or bill for 31237 because or lack of reimbursement or fear of unwarranted retribution by the insurers. The insurance companies have incorrectly interpreted this statistic to the patients' detriment. One or two debridements will not prevent scar tissue, recurrence of polyps or control chronic disease.
Dr. Brent Senior in the July 2001 issue of Nose News discussed that the post-operative period (30-45 days) usually consists of 3-7 debridements. This is more accurate. However, some insurers and insurance physician consultants consider this the total for the patient's lifespan. They deem further medical care unnecessary. This is inaccurate and should only be a guideline in the immediate post-operative period.
The American Academy of Otolaryngology has done extensive work to get the global period for FESS to zero. This was felt necessary so that otolaryngologists would perform the necessary debridements of infection, scar tissue and recurrent polypoid tissue in both the immediate post-op period (30-45 days) and afterwards depending on the case. There are many patients that need meticulous long-term care after the immediate post-operative period, especially those with chronic diseases including fungal sinusitis, bacterial chronic infection, recurrent polyposis and Sampters triad. Some of these patients may at certain times even require daily or weekly debridements. The physician should concurrently prescribe a complete medical regimen to control the chronic disease process and to decrease the need for frequent debridements, which are an adjunct to medical therapy. It is these patients that will suffer the most should care not be provided when necessary beyond the immediate post-operative period.
Quality care is expensive. Many insurers around the country have gotten around the zero global period by allowing care to be rendered by their contracted providers every 90 days. Insurance carriers fear that 31237 will be over utilized. To prevent this they have made physicians feel guilty about billing for it labeling them as "overutilizers." Similarly, others perform the procedure but don’t bill for it. Since when should physicians be ashamed and afraid to provide quality care? This is unfair to the patients that need and are not receiving follow-up debridements as their quality of life will probably be diminished, they may be at increased risk of complications of sinus disease and they may have an increased need for revision surgery in the operating room. Hopefully the insurance companies will come to realize, as did the original HCFA reviewers, that it is important to provide this care. Furthermore, it should actually decrease the costs of care long term and significantly improve the quality of life for the patient. It is up to us to provide quality care and to help patients get the insurance companies to understand that quality medical care is important.
This still remains a dilemma, but hopefully insurance companies and physicians alike will do the right thing. They will place the patient first and provide them with the best quality of care possible.
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