Changing trends in sinus and septal surgery, 2007 to 2009

Sinus surgery remains one of the most commonly performed procedures in the United States, with more than 600,000 patients undergoing sinus operations each year. Advances in our understanding of chronic rhinosinusitis (CRS), as well as the technology used to treat it, has resulted in significant changes in surgical management. The aim of this study was to identify recent changes in the performance and coding of certain endoscopic sinus surgical procedures (ESS) in the hope of generating further discussion and research in this area.

The MarketScan Research Database was used to query health insurance claims for all rhinological procedures performed between 2007 and 2009. Current Procedural Terminology (CPT) codes for sinonasal procedures that are endorsed by the American Medical Association were analyzed and compared to general otolaryngological procedures in an attempt to identify trends in the performance and coding of certain ESS procedures.

Compared to general otolaryngological procedures such as adenotonsillectomy, there was a statistically significant increase in the use of CPT codes for all ESS procedures between 2007 and 2009. The most marked interval changes were seen in the use of the CPT codes for procedures previously considered more complex, namely frontal sinusotomy (75%), sphenoidotomy (33%), and maxillary antrostomy with tissue removal (31%).

The performance of certain ESS procedures previously considered more complex due to anatomy, access, and proximity to vital structures has increased dramatically in the past few years, whereas increases in basic procedures have mirrored anticipated changes similar to those seen in general otolaryngological procedures.