Understanding 2018 CPT changes to FESS and BSD codes

February 2018 – Vol. 37, No. 1

The 2018 Medicare Physician Fee Schedule (MPFS) contains significant changes to the Endoscopic Sinus Surgery (FESS) and Ostial Sinus Dilation (BSD) family of codes. In January 2015, the FESS and BSD code families were captured in a CMS screen of services that are typically reported together more than 75 percent of the time. As a result, these codes were required by CMS to be reviewed no later than the 2017 MPFS rulemaking cycle.

The AAO-HNS has been working diligently for the past three years to ensure appropriate Medicare reimbursement for these services. Our initial recommendation for no action related to these code sets was rejected by CMS at the April 2015 AMA RVS Update Committee (RUC) meeting, and a request after the meeting also resulted in the requirement to move forward with bundled codes. To help mitigate the anticipated reductions, the Academy convened a task force in June 2015, which included experts from the American Rhinologic Society and the American Academy of Otolaryngologic Allergy. The task force created the combined codes and developed consensus recommendations for presentation to the RUC in January 2017.

The results of an RUC survey, which received a robust physician response, demonstrated a significant decrease in reported intraservice and total time required to complete many of the procedures in the code family. This was particularly significant in the FESS codes, which had not been surveyed since the early 1990s. The BSD codes, which had been surveyed more recently in 2011, produced data that was more consistent with the previous values, and thus their values were impacted far less.

Since the proposed values were released in July 2017, the AAO-HNS has been continuously engaged in advocating to CMS for appropriate valuation of these codes. CMS considered further reductions to many of these codes in the 2018 MPFS proposed rule. However, due to the Academy’s comments opposing these reductions (www.entnet.org/content/regulatory-advocacy), CMS elected to finalize the RUC-recommended values. 

To assist members in better understanding the new bundled codes, the Academy  prepared a CPT for ENT article, “Changes  to the FESS and BSD Family of Codes for  CY 2018.” To access this resource, visit  www.entnet.org/content/cpt-ent-FESS-BSD-code-changes-2018. The AAO-HNS worked with the above-mentioned task force to develop a CPT® Assistant article to address these coding changes. This article has been submitted to AMA and is pending publication.