Functional Endoscopic Sinus Surgery FESS

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Obstruction of the ostiomeatal complex,Opacified sinus. Recurrent Acute Rhinosinusitis with four or more episodes per year with distinct symptom free intervals between. episodes and all of the following,o Sinonasal symptoms and. o CT evidence of ostial occlusion and or mucosal thickening in the sinus to be treated. Any of the following conditions confirmed on CT scan. o Mucocele,o Concha bullosa,o Complications of sinusitis such as abscess. o Tumor confirmed such as polyposis or malignancy,DOCUMENTATION REQUIREMENTS. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws. that may require coverage for a specific service The documentation requirements outlined below are used to assess. whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested. Required Clinical Information,Functional Endoscopic Sinus Surgery FESS.
Medical notes documenting one or more of the following. Chronic Rhinosinusitis CRS with all of the following. o Persistence of symptoms despite administration of full courses of all of the following treatments. Antibiotic therapy if bacterial infection is suspected. Nasal lavage and,Intranasal corticosteroids, o Recent CT scan results confirming one or more of the following. Mucosal thickening,Bony remodeling,Bony thickening. Obstruction of the ostiomeatal complex,Opacified sinus. Recurrent acute rhino sinusitis with four or more episodes per year with distinct symptom free intervals. between episodes and all of the following,o Sinonasal symptoms and. o Recent CT scan results confirming evidence of ostial occlusion and or mucosal thickening in the sinus to be. Any of the following,o Mucocele,o Concha bullosa,o Complications of sinusitis.
o Recent CT scan results confirming tumor,DEFINITIONS. Acute Rhinosinusitis ARS ARS is a clinical condition characterized by inflammation of the mucosa of the nose. and paranasal sinuses with associated sudden onset of symptoms of purulent nasal drainage accompanied by nasal. obstruction facial pain pressure fullness or both of up to 4 weeks duration American Academy of Otolaryngology. Head and Neck Surgery AAO HNS Clinical indicators for endoscopic sinus surgery for adults 2012 Updated 2015. Chronic Rhinosinusitis CRS Chronic Rhinosinusitis is one of the more prevalent chronic illnesses in the United. States and is an inflammatory process that involves the paranasal sinuses and persists for longer than 12 weeks. Rosenfeld et al 2015 Peters et al 2014, Functional Endoscopic Sinus Surgery FESS FESS is a minimally invasive mucosal sparing surgical technique. utilized to treat medically refractory CRS with or without polyps or Recurrent Acute Rhinosinusitis. Recurrent Acute Rhinosinusitis RARS RARS has been defined as four episodes per year of Acute. Rhinosinusitis with distinct symptom free intervals between episodes Rosenfeld et al 2015. Functional Endoscopic Sinus Surgery FESS Page 2 of 7. UnitedHealthcare Oxford Clinical Policy Effective 11 01 2019. 1996 2019 Oxford Health Plans LLC,APPLICABLE CODES. The following list s of procedure and or diagnosis codes is provided for reference purposes only and may not be all. inclusive Listing of a code in this policy does not imply that the service described by the code is a covered or non. covered health service Benefit coverage for health services is determined by the member specific benefit plan. document and applicable laws that may require coverage for a specific service The inclusion of a code does not imply. any right to reimbursement or guarantee claim payment Other Policies may apply. CPT Code Description, 31240 Nasal sinus endoscopy surgical with concha bullosa resection. Nasal sinus endoscopy surgical with ethmoidectomy total anterior and posterior. 31253 including frontal sinus exploration with removal of tissue from frontal sinus when. 31254 Nasal sinus endoscopy surgical with ethmoidectomy partial anterior. 31255 Nasal sinus endoscopy surgical with ethmoidectomy total anterior and posterior. 31256 Nasal sinus endoscopy surgical with maxillary antrostomy. Nasal sinus endoscopy surgical with ethmoidectomy total anterior and posterior. including sphenoidotomy, Nasal sinus endoscopy surgical with ethmoidectomy total anterior and posterior.
including sphenoidotomy with removal of tissue from the sphenoid sinus. Nasal sinus endoscopy surgical with maxillary antrostomy with removal of tissue. from maxillary sinus, Nasal sinus endoscopy surgical with frontal sinus exploration including removal of. tissue from frontal sinus when performed, 31287 Nasal sinus endoscopy surgical with sphenoidotomy. Nasal sinus endoscopy surgical with sphenoidotomy with removal of tissue from. the sphenoid sinus, CPT is a registered trademark of the American Medical Association. DESCRIPTION OF SERVICES, Functional endoscopic sinus surgery FESS is a set of minimally invasive surgical techniques which allow direct visual. examination and opening of the sinuses for the treatment of chronic rhinosinusitis which has not responded to medical. treatment The use of FESS allows for a much less invasive and traumatic procedure resulting in shorter surgery and. healing times less postoperative discomfort and fewer surgical complications. Rhinosinusitis also referred to as Sinusitis is inflammation of the mucosal membrane lining the nasal cavities and the. paranasal sinuses Rhinosinusitis lasting more than 12 weeks is classified as Chronic Rhinosinusitis CRS Rosenfeld. et al 2015 Peters et al 2014, The goals of treating CRS are to eliminate underlying causes reduce sinus inflammation and drain nasal passages.
Medical therapy is the first line treatment for CRS Treatments recommended may include nasal saline sprays nasal. lavage antibiotic therapy nasal corticosteroids oral or injected corticosteroids decongestants over the counter pain. relievers leukotriene modifiers and antihistamines Patients who do not respond to medical therapy are candidates. for sinus surgery Marple et al 2011,CLINICAL EVIDENCE. Functional Endoscopic Sinus Surgery FESS, Sethi and Chakravarti 2016 conducted a single center prospective interventional study to evaluate the role of FESS. in refractory pediatric CRS and to assess the change in postoperative quality of life QOL Study included 35 children. aged between 6 and 12 years with refractory CRS not responding to 4 weeks of maximal medical. therapy Outcomes were evaluated via global assessment of Rhinosinusitis Symptom severity score and SN 5 QOL life. score both preoperatively and 1 year post surgery Results demonstrated that 91 4 children showed an. improvement in the total symptom severity score wand in their QOL at 12 months No major complications were. encountered in any of the cases The authors concluded that ESS is a safe and effective surgical management for. children with CRS refractory to maximal medical therapy leading to an improvement in their QOL. Functional Endoscopic Sinus Surgery FESS Page 3 of 7. UnitedHealthcare Oxford Clinical Policy Effective 11 01 2019. 1996 2019 Oxford Health Plans LLC, Koch et al 2016 performed a prospective comparative study to assess benefit of FESS with septorhinoplasty SRP. vs SRP alone in individuals with CRS with or without polyps and combined with a deformity of the outer. nose Participants n 110 were equally divided into the 2 surgical groups Prophylactic antibiotics and anesthesia. were the same for both groups The only difference between the 2 groups was actual operative time There were no. differences in postoperative inflammation or any other significant complication e g bleeding edema The authors. concluded that the combined FESS and SRP is a safe and effective method without an increased risk of complications. compared with SRP alone, Wang et al 2016 performed a single center comparative study to explore the effect of FESS on the treatment of. bronchiectasis combined with CRS 161 cases were divided into medication and operation groups according to their. selected therapeutic method For CRS the operative group underwent FESS versus pharmacologics alone for the. medication group The score of clinical symptoms for bronchiectasis forced expiratory volume in one second FEV1. sinonasal outcome test SNOT 22 score and Lund Mackay score were evaluated for all cases before and after. treatment respectively and then the value changes in the score of clinical symptoms FEV1 SNOT 22 score and. Lund Mackay score between both time points were calculated The frequency of acute exacerbation for bronchiectasis. was also recorded within the 6 month follow up This study revealed nearly 59 of cases with bronchiectasis also. had CRS Compared with pre therapy post therapy symptoms and scores in both groups were all significantly. decreased At 6 months the operation group experienced less frequent acute exacerbations and continued to exhibit. improved clinical symptoms and assessment scores than the medication group FEV1 did not improve in either group. when compared with pre therapy, Dalziel et al 2006 performed a systematic review of safety and effectiveness of FESS for the removal of nasal.
polyps All randomized controlled trials RCTs nonrandomized comparative studies and case series studies that. described outcomes associated with FESS for the excision of nasal polyps were included Forty two publications. comprised of 3 RCTs 4 nonrandomized comparative studies and 35 case series studies were included in the review. FESS was compared with endoscopic polypectomy Caldwell Luc radical nasalization and intranasal ethmoidectomy. In general studies were of poor quality and lacked description of important variables influencing surgical outcome. Overall complications for FESS from case series studies ranged from 0 3 to 22 4 Major complications ranged from 0. to 1 5 and minor complications ranged from 1 1 to 20 8 median 7 5 The potentially most serious. complications were cerebrospinal fluid leaks injury to the internal carotid artery dural exposure meningitis bleeding. requiring transfusion periorbital orbital fat exposure and orbital penetration Symptomatic improvement ranged from. 78 to 88 for FESS compared with 43 to 84 for comparative procedures From case series symptomatic. improvement ranged from 40 to 98 median 88 The authors concluded that FESS may offer some advantages in. safety and effectiveness over comparative techniques but wide variation in reported results and methodological. shortcomings of studies limit the certainty of these conclusions. Higgins et al 2011 conducted a systematic review with a pooled data analysis to compare outcomes of endoscopic. versus craniofacial resection of sinonasal malignancies The review included 15 case series with individual data on 226. patients The overall 5 year survival rate for the sample was 56 5 Because of the paucity of data with endoscopic. resection of high stage malignancies the outcome results were highly variable and no useful comparison could be. made Among low stage malignancies T1 2 or Kadish A B the endoscopic and open approaches demonstrated no. statistically significant difference in outcome results The 5 year overall survival was 87 4 in the endoscopic group. versus 76 8 for open approaches disease specific survival was 94 7 versus 87 7 and locoregional control rate. was 89 5 versus 77 2 The authors concluded that transnasal endoscopic resection appears to be a reasonable. alternative to craniofacial resection in the management of low stage sinonasal malignancies. In a systematic review Vlastarakos et al 2013 evaluated the quality of evidence in the use of FESS for the. treatment of CRS in children regarding the respective changes in their qualityof life QOL and the outcome that. follows the operation Fifteen studies were systematically analyzed Four represented Level II 5 Level III and 6 Level. IV evidence The total number of treated patients was 1301 Thirteen research groups reported that pediatric FESS is. an effective treatment for CRS the respective positive outcome ranged between 71 and 100 of operated children. Five studies concluded that this treatment modality is associated with significant improvement in the children s. postoperative QOL Systemic diseases and environmental factors may have unfavorable prognostic effects cystic. fibrosis is associated with at least 50 recurrence rate The rate of major complications following pediatric FESS is. 0 6 and the respective rate of minor complications is 2 The authors concluded that surgical management with. FESS in children with CRS is effective when optimal medical treatment proves unsuccessful grade B strength of. recommendation and is associated with improvement in the children s QOL grade B strength of recommendation. FESS also improves the sinusitis associated symptoms and QOL in children with cystic fibrosis grade C strength of. recommendation According to the authors most complications of pediatric FESS reported in the literature are minor. and associated with difficulties in the postoperative assessment and care of pediatric patients. Wood et al 2017 performed a prospective study to prospectively assess treatment outcomes of CRS patients. undergoing FESS and post operative medical treatment over a prolonged follow up period The study included 200. Functional Endoscopic Sinus Surgery FESS Page 4 of 7. UnitedHealthcare Oxford Clinical Policy Effective 11 01 2019. Functional endoscopic sinus surgery FESS is a set of minimally invasive surgical techniques which allow direct visual examination and opening of the sinuses for the treatment of chronic rhinosinusitis which has not responded to medical treatment The use of FESS allows for a much less invasive and traumatic procedure resulting in shorter surgery and healing times less postoperative

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