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News -> March, 2000 News
The American Rhinologic Society obtained legal counsel through the
Socioeconomic Committee concerning insurance carrier policy with respect
to post FESS coding of 31237 and 31231 for reimbursement. Certain third party
payers are flagrantly ignoring Medicare policy with respect to global
surgical periods while simultaneously alleging to follow Medicare's
resource-based relative value scale to set payment. However, the global
surgery period is inextricably linked to payment values. It appears
unreasonable, and at times unlawful, for a payer to suggest that it is
setting its payments based on the Medicare fee schedule, yet refusing to
adopt Medicare's global payment policy.
The ARS encourages members to
challenge inappropriate payer policies and request that the payer provide its
authority to establish a 90-day global period for FESS procedures. HCFA
assigned payment values for FESS assuming that medically necessary subsequent
diagnostic endoscopies (CPT code 31231) or surgical endoscopies with
debridement (CPT code 31237) would be reimbursed separately as outside the
zero-day global period.
In summary, physicians who are denied payment for post-operative FESS
endoscopies should vigorously appeal these denials. The ARS and our
Socioeconomic Committee through our legal counsel will provide support of
our members in this endeavor. For a more detailed discussion of the topic,
please see ARS Newsletter, Vol 20. No. 13, November, 1999.
HCFA has agreed to permit the use of CPT code 61795 for stereotactic assistance in sinus surgery. This change occurred through a
joint effort of the AAO-HNS, the ARS and the Neurosurgery organizations.
However, HCFA has not yet agreed to allow bilateral coding
for CPT codes 30930 (outfracture of turbinates), 30130 (turbinectomy), and
30140 (submucous resection, turbinate). Please channel all
your questions and data through the Chairman of the Socioeconomic Committee.
Joseph B. Jacobs, M.D.,
Chairman, Socioeconomic Committee, ARS
New York University Medical Center, New York, New York
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