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News -> April, 2002 News
Rebecca N. Gaughan, MD
AAO Chair-Elect BOG
 This article is in response to discussion generated from Dr. Brent Senior's informative article in last summer's edition of the ARS Newsletter entitled Packing and Post-operative Care Following Endoscopic Sinus Surgery: Who's Doing What? As Chair-Elect of the Board of Governors (BOG) I have heard reports of misinterpretation of this article.
I asked Dr. Richard Waguespack, Chair of the Carrier Relations Committee for the BOG and the Academyb's Advisor to the CPT Editorial Panel, to co-author this article with me. Hopefully, with your input, improvements in the number of denials or limitations on the payment of code 31237 in the office or clinic setting will be made.
Dr. Senior published the responses to two questions of members of the Board of Directors of the ARS. The question "What is your usual schedule of post-operative care?" was answered differently by eight experts. Their responses varied from 4-7 post-operative visits with some including debridement and others not.
Caution, however, must be taken in interpreting the data collected. This was simply a survey asking experts in the field how they usually care for the routine post-operative sinus patient.
The experts did not answer the following questions:
- Are there a set number of post-operative debridements recommended for any patient?
- Are there special types of sinusitis patients that require multiple debridements?
Richard W. Waguespack, MD, FACS
AAO Chair of the Carrier Relations Committee for the BOG
 The 2001 socioeconomic survey performed by the AAO-HNS Practice Management Department showed that nearly 40% of respondents never billed for post-endoscopic sinus surgery debridement [CPT 31237]; this result was not stratified into those that 1] did not perform the debridement or 2] did not routinely get paid, thus being "conditioned" not to submit claims. Of those who did file, only 15% always received third-party payment but over 40% were never reimbursed for the service.
One of the more recent developments has been creation of S2342, a Level II HCPCS code not recognized by Medicare, to describe bilateral, office-based, local or topical postop sinus debridement. This use of an S-code to reimburse [supplanting 31237] is of real concern to the AAO-HNS and has been brought to the AMA CPT Editorial Panel's attention.
One logical extension of the debate is whether otolaryngologists and their patients would be better served with an additional CPT code to specifically describe only office/clinic, local/topical postop debridement. The BOG would like your opinion on the following questions:
| Y |
N |
1 Do you typically perform 31237 for post-endoscopic sinus surgery debridement but do not submit a claim because your commercial carrier routinely disallows payment or bundles the service into the surgical global? |
| Y |
N |
2 Do your commercial carriers reimburse based on Medicare RVUs? [Please comment on carrier or percentile breakdowns in your locale.] |
| Y |
N |
3 Do any of your commercial carriers utilize S2342? |
| Y |
N |
4 On balance, would you benefit from a new CPT code to describe only office/clinic, local/topical postop debridement?
[Please comment.] |
Please voice your opinion by sending your response to Emily Pogash [epogash@entnet.org or via fax 703 299 1125] in the AAO-HNS Practice Management Department. Please indicate where you practice and who you represent.
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