What sinus procedure trends are prominent from 2000 to 2014, particularly following the introduction of balloon sinuplasty (BSP) in the Common Procedural Technology (CPT) codes in 2011?
Although the total number of sinus procedures increased from 2000 to 2014, the number of BSPs increased at a substantially greater rate since the introduction of CPT codes. BSPs still account for the minority of sinus procedures nationwide, however, despite its increased utilization.
Explore This IssueSeptember 2017
Background: Balloon dilation used to treat rhinosinusitis was approved by the U.S. Food and Drug Administration in 2005. The BSP procedure is intended to shorten recovery time, keep the nasal mucosa intact, and minimize postoperative care. As such, it is considered minimally invasive, can be performed in the clinic under local anesthesia, and does not require bone or tissue cutting, unlike functional endoscopic sinus surgery (FESS). Furthermore, reimbursement amounts are approximately 10 times greater for BSP compared to FESS. However, there has been some concern about BSP overutilization.
Study design: Retrospective review of Medicare procedure and beneficiary billing data from 2000 to 2014 and provider data from 2012 to 2014; for comparison, data on septoplasty procedures from 2000 to 2014 were obtained.
Setting: Centers for Medicare and Medicaid Services.
Synopsis: From 2000 to 2014, the total number of sinus procedures per 10 thousand beneficiaries (PP10K) nationwide increased from 17.2 to 26.2; sinus PP10K increased on average by 3.1% annually. From 2011 to 2014, the total non-balloon sinus procedures (nBSP) PP10K decreased from 21.9 to 19.9, with an average annual decrease of 3.1%. BSP PP10K increased from 1.6 in 2011 to 6.3 in 2014, with an average annual increase of 59%. Septoplasty PP10K changed modestly nationwide between 2000 and 2014, decreasing an average of 0.11% annually. By 2014, BSP accounted for 24.0% of sinus procedures nationwide. The percentage of BSP among all sinus procedures increased in all four U.S. census regions between 2012 and 2014 (West: 13.4% to 30.9%; Midwest: 17.2% to 32.9%; Northeast: 24.2% to 34.5%; South: 16.7% to 43.6%). States with the highest total BSPs from 2012 to 2014 were Texas (8,380), Florida (4,804), and California (3,897). Kansas (36.4), Texas (24.4), and Louisiana (24.2) had the highest total BSP PP10K from 2012 to 2014. There was a 244% increase in BSP-only providers, a 0.7% increase in nBSP-only providers, and an 83.3% increase in providers using both.
The national mean for three-year average Medicare payment amount per service was $1,647 for BSP and $353 for nBSP. The three states with the highest payment were Massachusetts ($2,270), New Jersey ($2,066), and Maryland ($2,053); the lowest were Nebraska ($617), South Carolina ($1,276), and West Virginia ($1,354). Limitations included a limited demographic, potential underrepresentation of FESS cases, and a lack of variables that could provide further insight into utilization patterns.