Rhinology refers to a subspecialty within the field of otolaryngology (ENT) focused on the treatment of diseases and disorders affecting the nasal cavity and sinuses. This may include allergies, problems with taste and smell, nose bleeds, obstructed nasal airflow, and sinusitis. These disorders are initially well managed by a General Ear Nose and Throat physician. However, when the problem persists or become more complex care may require consultation with a Rhinology specialist.
Procedures performed in Rhinology:
Below are the lists of procedures used to address the patient sinus and nasal diseases / deformities
- Balloon catheter dilation (balloon sinuplasty)- Balloon sinuplasty is a procedure that ear, nose and throat surgeonsmay use for the treatment of blocked sinuses.
- Endoscopic sinus surgery- Functional endoscopic sinus surgery (FESS) It is a minimally invasive surgical treatment which uses nasal endoscopes to enlarge the nasal drainage pathways of the paranasal sinuses to improve sinus ventilation.
- Endoscopic skull base surgery –Transsphenoidal surgery is a type of surgeryin which an endoscope and/or surgical instruments are inserted into part of the brain by going through the nose and the sphenoid bone (a butterfly-shaped bone forming the anterior inferior portion of the brain case) into the sphenoidal sinus cavity
- Rhinoplasty-Commonly known as a nose job, is a plastic surgeryprocedure for correcting and reconstructing the nose. Reconstructive surgery also treats birth defects, breathing problems, and failed primary rhinoplasties. Most patients ask to remove a bump, narrow nostril width, change the angle between the nose and the mouth, as well as correct injuries, birth defects, or other problems that affect breathing, such as deviated nasal septum or a sinus condition.
- Septoplasty- Septoplasty –is a surgical procedure to correct a deviated septum — a displacement of the bone and cartilage that divides your two nostrils. During septoplasty, your nasal septum is straightened and repositioned in the middle of your nose
- Turbinate surgery –Turbinate surgery, or inferior turbinate reduction, is a procedure where the inferior nasal turbinates are examined and reduced in size to provide improved nasal airflow.
Billing for Nasal Sinus Endoscopy
Ø According to the American Rhinologic Society, several nasal sinus endoscopy services were identified as potentially mis valued because billing patterns revealed they were billed together more than 75 percent of the time (same beneficiary/same day of service).
Ø As a result, the specialty societies were required to ‘bundle’ services together and create new codes that represented the combined services.
Ø When services are bundled, the Centers for Medicare & Medicaid Services (CMS) expects to see significant reductions in work relative value units (wRVUs) to account for inefficiencies.
Ø A partial and total ethmoidectomy are bundled with the new codes of endoscopic sinus surgery since each of the new codes includes a total ethmoidectomy.
Ø 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.
Ø 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.
Rhinology Diagnostic Conditions and Medical Necessity:
- Chronic sinusitis. Treatment of chronic sinusitis— also called chronic rhinosinusitis (CRS).
- Nasal polyps.
- Aspirin-exacerbated respiratory disease (Samter’s triad). .
- Revision sinus surgery.
- Hereditary haemorrhagic telangiectasia.
- Allergic Rhinitis
Modifier 50: Indicates a similar procedure performed on both the left and right sides during the same surgical session. This is applicable to all endoscopic sinus coding except nasal/sinus endoscopy, unilateral or bilateral.
Modifier 51: Indicates more than one surgical service performed by the same physician during the same surgical procedure. Identifies services subject to multiple procedure reductions.
Modifier 58: While not used as often in relation to endoscopic billing, this is applicable to secondary thyroid surgery for malignancy.
Modifier 59: Indicates a procedure or service not normally done together, or a separate incision, excision, or lesion. This code is increasingly being utilized.
Modifier 79: This unrelated procedure modifier is important with debridement codes. If you append this unbundling modifier, it should allow bypassing or overriding of payer edits