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Michael Setzen, M.D. Chair Patient Advocacy Committee and Sanford M. Archer, M.D., Member Patient Advocacy Committee
At our most recent Patient Advocacy Committee Meeting of the American Rhinologic Society in Washington DC, September 16th, 2007, it was brought to the attention of the Committee that there was confusion surrounding the use of CPT 31276.
CPT 31276 describes Nasal/sinus endoscopy, surgical, with frontal sinus exploration with or without removal of tissue from the frontal sinus.
The dilemma revolves around the uncertainty in applying 31276 and what the descriptor mandates is necessary in the surgical treatment for one to be able to use this code appropriately and fairly so that one can be reimbursed without denial.
Merely opening into the frontal recess by inserting a probe or suction catheter into the frontal sinus does not allow the use CPT 31276 and it is for this reason that the committee elected to clarify the use of this code more appropriately. It was the opinion of the committee that frontal sinus exploration requires the need to evaluate the nasal frontal recess with an endoscope and enlarge the opening passage into the frontal sinus with whatever modality one chooses be it a curette, a debrider, a balloon, or a curved suction. Furthermore, one must visualize the interior of the frontal sinus if at all possible. In so doing, two clinical goals will be achieved, and there is demonstrably additional physician work that goes beyond ethmoidectomy. Firstly, drainage from the frontal sinus will be enhanced and secondly, the mucosa of the frontal sinus will be evaluated.
It is understood that prior to performing surgery on the frontal sinus there must have been good documentation that the patient was, indeed, suffering from frontal sinus disease as documented on history, examination, or sinus CT.
One must continue to use common sense, good ethical judgment, and clear documentation when using this CPT code or ANY CPT code for that matter to avoid coding audits and potential penalties.
The committee will continue to evaluate 31276 and will respond again in the near future.
Should you have any questions with respect to 31276 and should you have been denied reimbursement when this code was applied appropriately, please feel free to contact the ARS Patient Advocacy Committee or the AAO-HNS Health Policy department at healthpolicy@entnet.org.
(Commentary was reviewed by Dr. Richard Waguespack, Chair of the AAO-HNS CPT/RVU Committee, and Ms. Linda Ayers, MHCM, Senior Director of Strategic Alliances & Health Policy at the AAO-HNS).
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