Balloon Dilation and Endoscopic Sinus Surgery - …

1 Please direct any questions document provides general reimbursement information to assist in obtaining coverage and reimbursement for healthcare services. These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Current Procedural Terminology (CPT) is copyright 2016 American Medical Association.

2 All Rights Reserved. Balloon Dilation AND Endoscopic Sinus Surgery HOSPITAL REIMBURSEMENT coding GUIDEBALLOON Dilation CODES AND Endoscopic Sinus Surgery CODESCPT codes 31295, 31296 and 31297 apply to cases in which a Balloon catheter is the only instrument/tool used and no tissue is removed. Do not report 31295, 31296 or 31297 with Endoscopic Sinus Surgery codes if performed together. As medically necessary, the use of a stereotactic guidance system may be reported in addition to the appropriate codes for the primary ENT procedure.

3 Documentation should explain both the medical necessity and pre-planning activities. CPT codes 61781, 61782, and 61783 are add-on codes and must be reported in addition to the primary Endoscopic Surgery coding GUIDE - 2016 PHYSICIAN coding AND PAYMENT IN HOSPITAL SETTINGRELATIVE VALUE UNITS (RVUs)22016 NATIONAL AVERAGE MEDICARE ALLOWABLE2 CPT Code1 Description1 GlobalPhysician Payment - Facility SettingPhysician Payment - Facility Setting30140 Submucous resection, inferior turbinate, partial or complete, any $45230420 Rhinoplasty, primary.

4 Including major septal $1,40530520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with $64130801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; $14031000 Lavage by cannulation; maxillary Sinus (antrum puncture or natural ostium) $10831002 Lavage by cannulation; sphenoid Sinus (antrum puncture or natural ostium) $19831231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) $6731233 Diagnostic endoscopy of nose and maxillary Sinus via inferior meatus $141 31237 Nasal/ Sinus endoscopy, surgical; with biopsy, polypectomy or debridements (separate procedure) $16731238 Surgical endoscopy of nose with control of nasal $17531240 Nasal/ Sinus endoscopy, surgical; with concha bullosa $16631254 Nasal/ Sinus endoscopy, surgical.

5 With ethmoidectomy, partial (anterior) $282 NASAL/ Sinus Endoscopic Surgery coding GUIDE - 2016 PHYSICIAN HOSPITAL coding RELATIVE VALUE UNITS (RVUs)22016 NATIONAL AVERAGE MEDICARE ALLOWABLE2 CPT Code1 Description1 GlobalFacilityFacility31255 Nasal/ Sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) $41531256 Nasal/ Sinus endoscopy, surgical, with maxillary $20531267 Nasal/ Sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary $32931276 Nasal/ Sinus endoscopy, surgical with frontal Sinus exploration; with or without removal of tissue from frontal $52331287 Nasal/ Sinus endoscopy, surgical, with $24031288 Nasal/ Sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid $27831295 Nasal/ Sinus endoscopy, surgical.

6 With Dilation of maxillary Sinus ostium ( Balloon Dilation ), transnasal or via canine $17031296 With Dilation of frontal Sinus ostium ( Balloon Dilation ) $20431297 With Dilation of sphenoid Sinus ostium ( Balloon Dilation ) $16661782 Stereotactic computer-assisted (navigational) procedure, cranial, extraduralN $1821. Current Procedural Terminology (CPT ). Copyright 2016 American Medical Association. 2. CMS Final Rule Physician Fee Schedule for CY2016. CODES APPLICABLE TO NUVENT EM Sinus Dilation SYSTEMC1726 - Catheter, Balloon dilatation, non-vascularNASAL/ Sinus Endoscopic Surgery coding GUIDE - 2016 HOSPITAL OUTPATIENT AND ASC coding MEDICARE OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (OPPS)HOSPITAL OUTPATIENT2 AMBULATORY SURGERY2 CPT Code1 Description1 APC2016 MEDICARE NATIONAL PAYMENTSTATUS INDICATOR32016 MEDICARE NATIONAL PAYMENT30140 Submucous resection, inferior turbinate, partial or complete, any method5164$1,616T$90430420 Rhinoplasty, primary.

7 Including major septal repair5165$3,956JI1,99430520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft5164$1,616T$90430801 Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method; superficial5163$690T$38631000 Lavage by cannulation; maxillary Sinus (antrum puncture or natural ostium)5162$313T$13931002 Lavage by cannulation; sphenoid Sinus (antrum puncture or natural ostium)5163$690T$38631231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)5151$141T$7931233 Diagnostic endoscopy of nose and maxillary Sinus via inferior meatus puncture5152$375T$21031237 Nasal/ Sinus endoscopy, surgical; with biopsy, polypectomy or debridements (separate procedure)5153$1,037T$58031238 Surgical endoscopy of nose with control of nasal hemorrhage5153$1,037T$58031240 Nasal/ Sinus endoscopy, surgical.

8 With concha bullosa resection5153$1,037T$58031254 Nasal/ Sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)5155$3,066T$1,71531255 Nasal/ Sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior)5155$3,066T$1,715 NASAL/ Sinus Endoscopic Surgery coding GUIDE - 2016 HOSPITAL OUTPATIENT AND ASC coding MEDICARE OUTPATIENT PROSPECTIVE PAYMENT SYSTEM (OPPS)HOSPITAL OUTPATIENT2 AMBULATORY SURGERY2 CPT Code1 Description1 APC2016 MEDICARE NATIONAL PAYMENTSTATUS INDICATOR32016 MEDICARE NATIONAL PAYMENT31256 Nasal/ Sinus endoscopy, surgical, with maxillary antrostomy5154$1,992T$1,11431267 Nasal/ Sinus endoscopy, surgical, with maxillary antrostomy.

9 With removal of tissue from maxillary sinus5155$3,066T$1,71531276 Nasal/ Sinus endoscopy, surgical with frontal Sinus exploration; with or without removal of tissue from frontal sinus5155$3,066T$1,71531287 Nasal/ Sinus endoscopy, surgical, with sphenoidotomy5155$3,066T$1,71531288 Nasal/ Sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus5155$3,066T$1,71531295 Nasal/ Sinus endoscopy, surgical; with Dilation of maxillary Sinus ostium ( Balloon Dilation ), transnasal or via canine fossa5155$3,066T$1,71531296 With Dilation of frontal Sinus ostium ( Balloon Dilation )5155$3,066T$1,71531297 With Dilation of sphenoid Sinus ostium ( Balloon Dilation )5155$3,066T$1,71561782 Stereotactic computer-assisted (navigational)N /APackagedNPackaged1.

10 Current Procedural Terminology (CPT ). Copyright 2016 American Medical Association. 2. CMS Final 2016 Outpatient Rule - CMS-1633-FC/CMS-1607-F2. Fee schedules are national averages and are not geographically Status Indicator of T means separate APC payment, multiple reduction Status Indicator of JI means comprehensive only. Refer to product instruction manual/package insert for instructions, warnings, precautions and contraindications. For further information, please call Medtronic ENT at and/or consult Medtronic s website at is a trademark of Medtronic, Inc.