How Do You Code Sinuva Placement for NGS Medicare? Find Out Here

otolaryngology coding for Sinuva implant

A new HCPCS Level II code lets you report the SinuvaTM implant for nasal polyps, but coding for placement may vary based on the encounter. Medicare Administrative Contractor (MAC) National Government Services has some advice for its providers. Here’s what you need to know if you perform coding for otolaryngology.

Update HCPCS Coding for Oct. 1, 2019, and Later

Sinuva is an in-office drug treatment for recurrent nasal polyps, according to Intersect ENT, as reported in the May 15, 2018, Centers for Medicare & Medicaid Services (CMS) HCPCS Public Meeting Agenda.

Following the Oct. 1, 2019, HCPCS Level II updates, the appropriate code for the Sinuva implant itself is J7401 (Mometasone furoate sinus implant, 10 micrograms). For services before Oct. 1, 2019, National Government Services instructs providers to report J3490 (Unclassified drugs). If you’re required to report the National Drug Code (NDC) on the claim, it is 10599000301.

The implant delivers 1,350 mcg of mometasone furoate, a corticosteroid, directly to the ethmoid sinus, the agenda states. The implant releases the drug gradually over 90 days.

Units: The code descriptor for J7401 indicates you report 1 billing unit per 10 mcg. So for 1,350 mcg you should report 135 units (1,350 mcg divided by 10 mcg/unit is 135 units). For bilateral placement (two implants), you would report twice the units, which is 270 units.

Base Sinuva Placement CPT® Code on Services Performed

If the physician, such as an otolaryngologist, places Sinuva without any other nasal or sinus endoscopic service, National Government Services instructs its providers to report 31299 (Unlisted procedure, accessory sinuses) for the implant procedure.

Reporting unlisted procedures: If you report 31299, follow your payer’s rules for submitting unlisted procedure codes. For instance, when discussing unlisted procedure codes, AMA’s CPT® Assistant typically suggests submitting supporting documentation with the claim to describe the procedure’s nature and extent and to show why the patient needed the procedure. The advice also includes showing the time, effort, and equipment involved in the procedure. Your payer may provide more specific guidance, including technical instructions on how to submit the claim and documentation.

31237: When the physician places Sinuva endoscopically in the ethmoid sinus in conjunction with biopsy, polypectomy, or debridement, you should report 31237 (Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)) for the complete service, National Government Services states.

In other words, the CPT® code set does not currently have a specific code for placement alone, and your payer is likely to instruct you to bundle the placement into other endoscopic sinus procedures performed at the same session.

Expect a Code From Nasal Polyp ICD-10-CM Category

The National Government Services guidance doesn’t mention ICD-10-CM coding. But because Sinuva is a treatment for nasal polyps, you can expect the documentation to support reporting one of these codes from J33.- (Nasal polyps):

  • J33.0 (Polyp of nasal cavity)
  • J33.1 (Polypoid sinus degeneration)
  • J33.8 (Other polyp of sinus)
  • J33.9 (Nasal polyp, unspecified)

Don’t make assumptions about the diagnosis, though. Base your ICD-10-CM code choice on the documentation for the specific case you’re reporting.

Final note: Accurate coding does not guarantee coverage. Check individual policies to be sure your practice and the patient understand the relevant coverage policy.

What About You?

Do you code for Sinuva implants? Does this guidance match what you’ve been reporting? The physician must remove the implant at 90 days or earlier. How are you handling coding for this encounter?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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