Debridement of the Sinus Cavity after FESS

Debridement of the sinus cavity is a procedure frequently done following FESS. It involves transnasal insertion of the endoscope for visualization and parallel insertion of various instruments for the purpose of removal of postsurgical crusting, devitalized mucosa or other contaminated tissue. It is performed under local or general anesthesia in an office suitably equipped or operating room, depending on the clinical circumstances of the case.

It is the position of the Academy that post-operative debridement will lead to less likelihood of post-operative recurrence of sinus disease. This is particularly the case in recurrent/persistent bacterial infections and/or fungal sinusitis.

1. The frequency with which the above mentioned procedure should be performed is a clinical judgement best made by the surgeon and determined on a case-by-case basis, with clinical interests of the patient the criteria of need. Setting an arbitrary limit on the number of debridements can severely jeopardize the quality of care which the patients receive and negatively affect the overall outcome of such sinus surgery.
2. The Medicare fee schedule, the source for the concept of global periods, clearly assigns zero follow-up days to the 31237 code and most FESS procedures (several have a 10 day period: 31239 and 31290-31294). The reason for this assignment is that in the initial formulation of the relative value units for FESS, need for debridement of the sinus cavity was noted to vary greatly depending on the individual surgical case. FESS surgery relative value units were developed with this exclusion of debridements factored into their overall weight: FESS code values do not include the work, risk, judgement, and skill necessary for this separate procedure.

Medicare work values assigned to the various codes for FESS surgery took into account all of these factors and others. Haphazardly assigning lower work-valued codes in the place of 31237 as well as tampering with the Medicare global periods assigned, leads to the skewing of several of the key elements which were arrived at to produce fairness and equitable payments for the work done. This results in incorrectly lowered payments, inconsistent with the level, volume, and intensity of the work performed.

1. Insurance companies which profess to use Medicare approaches to reimbursements should use all of the critical elements of those formulations to be consistent with the work values and payment rules inherent in the Medicare concepts mentioned.
2. Sinus surgery is unilateral in nature as are debridements done thereafter. Payments for these procedures should be also.

Adopted 8/5/99

Guidelines are not a substitute for the experience and judgment of a physician and are developed to enhance the physicians' ability to practice evidence-based medicine.

Important Notice

The American Academy of Otolaryngology-Head and Neck Surgery, Inc. and Foundation (AAO-HNS/F) Policy Statements are guidelines only. In no sense do they represent a standard of care. The applicability of an indicator for a procedure, and/or of the process or outcome criteria, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these guidelines will not ensure successful treatment in every situation. The AAO-HNS emphasizes that these policies should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.