Coding Update for Balloon Dilitation & Image-Guided Surgery

Pete S. Batra, MD, FACS

In October 2009, AAO-HNS submitted 3 new code requests to the AMA for Category I CPT codes for use of stand-alone balloon devices for sinus dilation. The Medicare Physician Fee Schedule, published on November 24th, 2010 includes the 3 new code proposals, along with the recommended work and practice expense relative value units (RVUs). The new codes are as follows:
  • 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, balloon dilation), transnasal or via canine fossa (Do not report 31295 in conjunction with 31233, 31256, 31267 when performed on the same sinus)
  • 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium (eg, balloon dilation) (Do not report 31296 in conjunction with 31276 when performed on the same sinus)
  • 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid sinus ostium (eg, balloon dilation) (Do not report 31297 in conjunction with 31235, 31287, 31288 when performed on the same sinus)
Codes 31295-31297 describe dilation of sinus ostia by displacement of tissue, any method, and include fluoroscopy if performed. The surgical sinus endoscopy includes a sinusotomy (when appropriate) and diagnostic endoscopy. These codes should be reported as unilateral procedures, with a -50 modifier appended for bilateral cases.

The parenthetical notes indicate which codes should not be used together. In this case, balloon dilation codes should not be reported with the existing codes for the same sinus. For example, if maxillary antrostomy is performed using balloon as a sinus dilation tool with concurrent removal of uncinate process and polypoid tissue at the maxillary opening, 31256 (nasal/sinus endoscopy, surgical; with maxillary antrostomy) should be reported. 31295 should not be reported for the balloon dilation of the maxillary sinus in this specific case. If any service is not accurately reflected by an existing CPT code, the unlisted 31299 should always be reported.

The work, facility and non-facility practice expense, and malpractice RVUs for these new codes are listed below:

CPT wRVU Non-Facility PE RVU Facility PE RVU Malpractice RVU Global Period
31295 2.70 57.07 2.12 0.35 0
31296 3.29 108.70 2.47 0.42 0
31297 2.64 108.37 2.08 0.34 0

Codes 31295-31297 will also be billable in the ambulatory surgery center (ASC) setting starting January 1st, 2011. The anticipated 2011 national ASC rate is $1,198.96 for each code.

image-guidance coding update
Image guidance code 61795 (stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal) will be deleted in 2011. This will be replaced by 3 codes to reflect work performed by otolaryngologists, neurosurgeons, and spine surgeons during image-guided surgery.
  • 61781 Stereotactic computer assisted procedure, intradural, cranial
  • 61782 Stereotactic computer assisted procedure, extradural, cranial
  • 61783 Stereotactic computer assisted procedure, spinal
These codes should be listed separately in addition to the code for the primary procedure. Image guidance during endoscopic sinus surgery should be coded with 61782. The work RVUs for 61782 will be 3.18, compared to 4.03 for the previous 61795. The work RVUs for 61781 and 61783 will be slightly higher at 3.75.

The ARS Patient Advocacy Committee will continue to partner with the academy and closely monitor changes related to coding that may impact the practice of rhinology. Continue to look for updates on the the ARS website and the Facebook page.

References
  1. Coding for Balloon Sinus Dilation 2011. http://www.aaohns.org/Practice/Coding-for-Balloon-Sinus-Dilation-2010.cfm. Accessed November 30th, 2010.
  2. Medicare Program; Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2011. Federal Register Vol. 75, No. 228. November 29, 2010.
  3. 2011 National ASC rates. www.beckersasc.com. Accessed November 30th, 2010.

CPT wRVU Non-Facility PE RVU Facility PE RVU Malpractice RVU Facility Rate Non-Facility Rate
31295 2.70 57.07 2.12 0.35 $175.66 $2,042.66
31296 3.29 108.70 2.47 0.42 $209.97 $3,819.29
31297 2.64 108.37 2.08 0.34 $171.92 $3,783.27

Calculated using 2011 conversion factor ($33.9764)

 

Revised 12/2010
©American Rhinologic Society
 
 

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