Otolaryngologists Increasingly Move Inferior Turbinate Surgery into the Office

Dr. Hwang said that in his own practice, he has not encountered any reimbursement or coding challenges that were not insurmountable, provided a few basic tenets were followed. “It’s crucial that you carefully document physical examination findings of turbinate hypertrophy to establish medical need,” he said. It’s also important, he added, to document that the patient has failed an adequate course of medical therapy before surgery is considered; otherwise, payers may balk at reimbursing for the procedure.

Another important consideration in making the transition to office-based ITH is to have a firm grasp on which of the many methods of reducing the turbinates can be done safely and effectively in the outpatient setting, Dr. Hwang said. “While many options have been shown to be efficacious, each method has its own equipment requirements and technical concerns that should be considered carefully by the surgeon,” he said. Dr. Hwang added that he prefers microdebridement, citing published evidence of excellent long-term outcomes with this technique (Laryngoscope. 2006;116:729-734, and 2009;119:414-418). But he does not perform a related procedure, turbinate outfracture, in office-based settings. “I am more comfortable doing that in the hospital, where the patient is [under anesthesia],” he said.

Dr. Setzen said he does not have a problem doing outfracture in the office, but added that there are more important considerations when deciding on a strategy for performing office-based ITH surgery. For example, there are safety factors to consider when making the outpatient transition, such as having the appropriate emergency equipment on hand. “You have to be prepared in the unlikely event that a complication occurs, such as a serious bleed or an airway obstruction,” Dr. Setzen said. “Remember, in most cases we don’t have an anesthesiologist or other physician helping us, so you need to be ready to resuscitate a patient or perform some other emergency intervention.”

Drug-related adverse events are another risk physicians need to be prepared to face, Dr. Setzen noted. “When we operate on the nose, we generally inject a local anesthetic with epinephrine, which can cause tachycardia and other arrhythmias. So you need to be sure that the patient is medically in good enough shape to tolerate the procedure, because the last thing you want is for a cardiopulmonary event to take place in the office.”