CPT® Code 0407T

Code deleted, see 31299, 31237

Official Description

with biopsy, polypectomy or debridement

Common Language Description

An endoscopic procedure, specifically designed for the examination of the ethmoid sinus, is performed to facilitate the placement of a drug-eluting implant. This procedure may also involve surgical debridement, biopsy of sinus tissue, or the removal of polyps, depending on the clinical situation. The indications for conducting a nasal endoscopy with the placement of a drug-eluting implant primarily include chronic rhinosinusitis (CRS), which is characterized by inflammation of the paranasal sinuses and the lining of the nasal passages that persists for more than 12 weeks and does not respond adequately to medical management. The overarching goal of this procedure is to restore normal physiological ventilation and drainage of the sinuses. During the procedure, a rigid or flexible endoscope is inserted through the nasal passage and advanced to the ethmoid sinus, which is situated between the eyes. If polyps are present, they are excised using a snare, and tissue samples may be collected with biopsy forceps when necessary. The procedure also involves the introduction of a synthetic bio-absorbable implant that contains a steroid compound into the ethmoid sinus via a proprietary endoscopic delivery system. Once delivered, the implant expands and adapts to the contours of the sinus cavity, effectively stabilizing the middle turbinate to prevent the formation of obstructive adhesions and to mitigate swelling. It is important to note that CPT® Code 0406T encompasses surgical nasal endoscopy of the ethmoid sinus along with the placement of a drug-eluting implant, while CPT® Code 0407T specifically includes the same endoscopic procedure but with the additional components of biopsy, polypectomy, or debridement.

1. Indications

The indications for performing a nasal endoscopy with the placement of a drug-eluting implant include the following:

Chronic Rhinosinusitis (CRS) - A condition characterized by inflammation of the paranasal sinuses and the lining of the nasal passages lasting longer than 12 weeks, which is unresponsive to medical management.
Inflammation of the Para-nasal Sinuses - Persistent inflammation affecting the sinuses that may require surgical intervention for relief.
Nasal Passage Lining Inflammation - Ongoing inflammation of the nasal passage lining that necessitates examination and potential treatment through endoscopic means.

2. Procedure

The procedure involves several key steps that are critical for successful execution:

Step 1: Insertion of Endoscope - A rigid or flexible endoscope is carefully inserted through the nostril and advanced to the ethmoid sinus, which is located between the eyes. This allows for direct visualization of the sinus cavity and surrounding structures.
Step 2: Surgical Intervention - If indicated, the surgeon may perform a polypectomy, which involves the removal of any polyps present in the sinus cavity using a snare. Additionally, biopsy forceps may be utilized to obtain tissue samples for further analysis, ensuring that any abnormal tissue can be evaluated.
Step 3: Placement of Drug-Eluting Implant - Following the surgical interventions, a synthetic bio-absorbable implant containing a steroid compound is introduced into the ethmoid sinus. This is accomplished using a proprietary endoscopic delivery system designed for this purpose. Upon delivery, the implant expands and conforms to the anatomy of the sinus cavity.
Step 4: Stabilization of Middle Turbinate - The expanding implant stabilizes the middle turbinate, which is crucial for preventing obstructive adhesions and reducing inflammation within the sinus cavity, thereby promoting better sinus drainage and ventilation.

3. Post-Procedure

Post-procedure care may include monitoring for any complications related to the endoscopic intervention, such as bleeding or infection. Patients are typically advised on follow-up appointments to assess the effectiveness of the implant and the overall condition of the sinuses. Recovery may involve managing any discomfort and following specific instructions regarding nasal care to ensure optimal healing and function of the sinuses.

Short Descr	SIN NDSC PLMT DRG ELUT MPLNT
Medium Descr	NSL NDSC SURG ETHMD PLMT DRUG ELUTNG IMPLNT W/BX
Long Descr	with biopsy, polypectomy or debridement
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	T-Packaged Codes
Berenson-Eggers TOS (BETOS)	P8I - Endoscopy - other
MUE	Not applicable/unspecified.