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Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. Sign-up to receive this newsletter by clicking here.
The AMA has given us three new CPT codes in 2011 that represent sinus dilation procedures for increasing the size of the natural sinus ostium(s) (openings into the sinus cavities). Any time new codes are published the first thing a coder should do is review the guidelines that are associated with those new CPT codes. These guidelines can be found under the heading of "Endoscopy" at the beginning of the endoscopic sinus surgery code section and state the following: "Codes 31295-31297 describe dilation of sinus ostia by displacement of tissue, any method, and include fluoroscopy if performed." We are most familiar with a balloon dilation procedure but remember, a dilation can be performed by ANY METHOD and it's common for the balloon catheter to be placed across the sinus ostium using fluoroscopic guidance which is not additionally reported.
A couple of observations about the codes themselves. First, dilation of the maxillary sinus ostium can be achieved by a transnasal (through the nose) or canine fossa approach. If you lifted your lip and looked at the area of the canine tooth (fang) you would see a small depression just above the canine tooth socket — this area is known as the canine fossa and the approach can be made from this area when dilating the maxillary sinus ostium. So the approach does not have to be through the nose.
Also notice that there are dilation codes for the maxillary, frontal and sphenoid sinuses – there isn't a code for dilation of the ethmoid sinuses. Codes 31254/31255 read "ethmoidectomy" which is the removal of ethmoid air cells. Dilation procedures DO NOT remove any tissue. For this reason a balloon dilation of the ethmoid sinuses is reported with Unlisted CPT code 31299.
This leads us to another area of confusion. AMA guidelines stipulate that when a dilation procedure is performed as the only service a dilation code is reported. However, when surgical cutting instruments are inserted after the dilation procedure to further open or widen the ostium (and when performed) remove tissue from within the sinus cavity, then one of the "old" codes from the endoscopic sinus surgery section is reported and the balloon dilation becomes inclusive and is not reported.
There is a misconception that just because cutting instruments are inserted to perform a total ethmoidectomy, a subsequent dilation of the maxillary sinuses can be reported with codes from the 31256/31267 series. That is incorrect, the above mentioned service would be reported as 31255 and 31295 — the 31256-31267 codes would only be used when maxillary dilation occurs and cutting instruments are used on/in the maxillary sinus. Watch for this distinction whenever you see the term "hybrid" procedure. This is an indication that a dilation and surgical excision procedure are being performed on the same sinus.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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