Published: March 29, 2016

CPT Assistant: drug-eluting sinus implant (CPT 0406T, 0407T)

For 2016, Current Procedural Terminology (CPT®) codes 0406T Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; and 0407T with biopsy, polypectomy or debridement were created. In order to help otolaryngologist-head and neck surgeons correctly code, the Academy’s CPT team helped the American Medical Association (AMA) draft a CPT Assistant article on the placement of a drug-eluting implant into the ethmoid sinus.


For 2016, Current Procedural Terminology (CPT®) codes 0406T Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; and 0407T with biopsy, polypectomy or debridement were created. In order to help otolaryngologist-head and neck surgeons correctly code, the Academy’s CPT team helped the American Medical Association (AMA) draft a CPT Assistant article on the placement of a drug-eluting implant into the ethmoid sinus.

The following AMA CPT Assistant article, “Drug-Eluting Sinus Implant (Codes 0406T, 0407T),” which can be found on page 10 of the February 2016 CPT Assistant, is re-published with permission from the AMA.

Codes 0406T and 0407T describe the placement of drug-eluting implant into the ethmoid sinus by a physician or other qualified healthcare professional. The implant is intended to remain in place for days to weeks and slowly elute a drug into the ethmoid sinus cavity mucosa while disintegrating. These codes apply only to manufactured drug-eluting implants (medication is integral to and embedded within the device), and are not for the placement of packing or other material (e.g., sponge, dressing, gel or foam), which has been soaked in, or mixed with, steroid or another medication.

Code 0406T is reported when the procedure is performed as a stand-alone service, whereas code 0407T is reported when the procedure is performed at the same session as a biopsy, polypectomy, or debridement (typically, the latter) involving the ethmoid sinus. Both codes describe procedures performed only within the ethmoid sinuses, which are located between the eyes and nasal cavity behind the bridge of the nose. It would not be appropriate to report code 0406T in conjunction with 0407T, if the procedure were performed on the same side during the same session. A new parenthetical reference note has been added following code 0407T to instruct users that both codes should not be reported together for the same ethmoid side/site during the same session.

All nasal endoscopy codes include the work of performing the endoscopy, as well as any packing that is used at the conclusion of surgery. These codes also encompass the placement of a stent or implant that is used to maintain the patency of the cavity, achieve hemostasis, or elute a medication. Therefore, codes 0406T and 0407T should not be reported in addition to open or endoscopic ethmoid sinus surgery on the same side because the placement of any packing or stent, including a drug eluting implant, is considered inherent to those procedures.

A new parenthetical reference note was added to instruct users that codes 0406T and 0407T should not be reported in conjunction with code 31200 (ethmoidectomy, anterior); 31201 (ethmoidectomy, intranasal); 31205 (ethmoidectomy, extranasal); 31231 (nasal endoscopy, diagnostic); 31237 (nasal endoscopy surgical, with biopsy, polypectomy or debridement); 31240 (concha bullosa resection); 31254 (endoscopic ethmoidectomy, partial); 31255 (endoscopic ethmoidectomy, total); 31288 (endoscopic sphenoidotomy with removal of tissue); or 31290 (endoscopic repair of cerebrospinal fluid leak, ethmoid), when performed on the same side.

In the event that the endoscopic placement of a drug-eluting implant is performed during the same session but on the opposite side as a primary ethmoidectomy, it would be appropriate to report the code for the endoscopic procedure along with code 0406T or 0407T. Modifier 59 should be appended to the additional code to indicate that a distinct procedural service was performed. Placement of a drug-eluting implant into any sinus other than the ethmoid should be reported with unlisted code 31299. Third-party payers may have different reporting guidelines; therefore, check with your individual third-party payers regarding their specific reporting guidelines.

The full article is available to Academy Members at www.entnet.org/content/ama-cpt-assistant-drug-eluting-sinus-implant-cpt-0406t-0407t (login required).

 


More from April 2016 - Vol. 35, No. 03