CODING: New FESS Codes for 2018

medical-coding-icon2018 brings us new functional endoscopic sinus surgery codes (FESS) which bundle a total ethmoidectomy with both a frontal sinusotomy and a sphenoidotomy with and without removal of tissue.  2018 CPT® also provides a new bundled code for a frontal and sphenoid endoscopic balloon dilation.  On initial review of these new codes and the instructions in the AMA CPT® code book,  it is confusing as to how to one should code when 3 or 4 sinuses are operated on the same side.

Three New FESS Codes:

The new codes for 2018 are:

31253:  Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed

31257:  Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy

31259:  Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus

It makes sense that a partial and total ethmoidectomy are bundled with the new codes, 31253, 31257, and 31259 since each of the new codes includes a total ethmoidectomy.  A maxillary antrostomy still stands alone and is not included in any of the codes, so the combination codes only include the anterior and posterior ethmoid sinuses along with the frontal and sphenoid sinuses.  So, if a maxillary antrostomy is performed with a total ethmoidectomy and a frontal sinusotomy on the same side, it would be coded with the combination codes 31253 plus 31256 if no tissue was removed and plus 31267 if tissue was removed.  If a maxillary antrostomy, total ethmoidectomy, and sphenoidotomy are performed on the same side, there are a few combinations of codes that may apply, depending if tissue was taken out of the maxillary sinuses and/or sphenoid sinuses.  They are:

31257 and 31256 if no tissue was removed from either maxillary or sphenoid sinuses

31257 and 31267 if tissue is only removed from the maxillary sinus

31259 and 31256 if tissue is only removed from the sphenoid sinus

31259 and 31267 if tissue is removed from both the maxillary and sphenoid sinuses

FESS Final Question:
The final question is how will it be coded if all four sinuses are operated on the same side?  The AMA should be issuing guidance for this via CPT® Assistant soon, but in the meantime, guidance from high ranking physicians of the AAO/HNS have indicated the following:

All 4 sinuses (with no removal of tissue) can be coded in one of two ways:

31253, 31287, 31256 or 31257, 31276, 31256

If tissue is removed, 31287 and/or 31256 would be replaced with 31288 and/or 31267 in the first coding combination or 31257 and/or 31256 would be replaced with 31259 and/or 31267.

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