Sinuplasty Gaining Momentum for Sinus Procedures

In current practice, he said, doctors can use sinuplasty as a pure procedure with just the balloon technique or it can be used in a hybrid fashion-balloon remodeling along with some surgery, usually ethmoidectomy.

Case Histories Illustrative

He showed case histories illustrating each of the techniques:

An example of pure sinuplasty is a 35-year-old woman Realtor, who five months previously had undergone right molar extraction with resultant oroantral fistula. She was treated with more than 60 days of antibiotics, three months of nasal steroid spray, and four failed attempts to surgically close the fistula. She underwent sinuplasty with isolated remodeling of the right maxillary outflow tract. The last follow-up was 12 weeks after the operation and she was doing well. The fistula closed spontaneously.

An example of a hybrid procedure involved a 63-year-old woman with a primary complaint of left maxillary region swelling along with recurrent infections. She was treated with more than 30 days of antibiotics prior to examination with computer-assisted tomography. Her condition was nonacute at the time the CT scan was performed. She also had a greater than three-month course of nasal steroid spray and had two courses of primary care prescribed oral steroids. She underwent a hybrid procedure. The balloon sinuplasty remodeled the frontal, maxillary, and sphenoid sinuses. She also underwent a traditional total ethmoidectomy. After 21 months she is doing well without complaints.

Dr. Weiss said that clinicians using sinuplasty need to take time to consolidate their work before moving forward with the developing field. We need to not get ahead of ourselves. It will require good studies to further prove its effectiveness, repeatability and sustainability. It must be done through the peer review process, he said.

I don’t think we have a repeatability issue with this, he said. I have done over 200 of these procedures and although I have been doing them for a long time, I don’t think there is any reason other doctors cannot accomplish the same thing.

Proper Coding for Sinuplasty

Getting reimbursed for sinuplasty requires the use of the proper codes, said Dr. Setzen. Use of pure sinuplasty requires the use of CPT Unlisted Code 31299. In performing the hybrid procedure, Dr. Setzen said the codes are for functional endoscopic sinus surgery:

• 31256 for the maxillary sinus, 31267 if tissue is removed.
• 31287 for the sphenoid sinus, 31288, if tissue is removed.
• 31276 for the frontal sinus.

Dr. Setzen said the professional American Academy of Otolaryngology-Head and Neck Surgery, in its opinion on New Surgery for Sinus Balloon Catheterization, suggested: First and foremost, we feel the physician should code for the work done based on the CPT descriptor for the code.