January 2009: Point-of-Service CT in Rhinology

Michael Setzen MD and Pete Batra MD

Point-of-service (POS) or in-office CT is becoming more popular today with both patients and otolaryngologists. POS CT enhances patient care by improving the quality of care and convenience that we as a specialty can offer our patients. This diagnostic modality enhances patient satisfaction as the otolaryngologist is able to review the imaging study with the patient at the time of the office visit prior to initiating treatment.

In-office CT may be instrumental in management of our patients in several clinical scenarios. This option is particularly important in the headache patient who is convinced that his or her headache is due to sinusitis. Timely imaging may help confirm or refute this diagnosis. It is helpful in the early postoperative period when the patient complains of facial pain, headache or fever to rule out potential complications. It is useful on the weekend and after hours when requesting a CT in the emergency department could take hours. In addition, it is of important in the patient that meets symptom criteria for chronic rhinosinusitis (CRS) but has normal endoscopy. POS CT will help establish accurate diagnosis and institute appropriate medical therapy in a timely fashion.

A recent case-control study evaluated management of 40 consecutive new patients meeting symptom criteria for CRS with negative endoscopy that underwent point-of-care (POC) CT.1They were compared to 50 patients in the pre-POC CT era whose initial treatment was based on symptoms alone. Interestingly, 10 patients (20%) in the pre-POC CT group were lost to follow-up. Patients undergoing POC CT were more likely to receive oral steroids for management of CRS and were less likely to be lost to follow-up.

From the patient’s perspective, POS offers several advantages. There are no scheduling delays as the CT can be performed immediately with no additional time away from work or school. This obviates the delay before the patient is informed of the results, by which time they may already be well and unnecessary medications, especially antibiotics and/or steroids, may have been used. Furthermore, the cone-beam technology delivers a lower radiation dosage than traditional facility-based CT. This may be particularly important for pediatric patients to minimize cumulative lifetime radiation exposure.

In spite of this, many radiology benefit management (RBM’s) companies will not precertify an otolaryngologist and, therefore, the service will not be reimbursed. RBM's would rather approve a radiology-owned office performing these services especially in the New York area. In-office CT allows the otolaryngologist to diagnose and treat the patient in one visit with complete documentation of the patient's problem. We must continue to challenge these RBM's which are unfairly curtailing the ability of the practicing otolaryngologist to perform in-office CT in the interest of quality patient care.

The standard of care with respect to an otolaryngologist officially reading the report is not well established at this time. It would be most prudent for otolaryngologists to review the CT with the patient and offer a provisional report but send the films electronically to a radiologist for an official reading.

CPT codes are as follows:
  • CT Sinus 70486
  • CT sinus follow-up 76380
Always link the CPT code with an appropriate ICD-9 code and document medical necessity.

1. Conley DB, Pearlman AN, Zhou K, et al. Effect of point-of-care miniCT on treatment of chronic rhinosinusitis. Poster presentation. 2008 ARS Annual Fall Meeting. Chicago, Illinois.

Revised 1/2009
©American Rhinologic Society