Practice patterns in endoscopic skull base surgery: survey of the American Rhinologic Society

The introduction of advanced endoscopic techniques has facilitated significant growth in the field of endoscopic skull base surgery (SBS). The purpose of this study is to evaluate the impact of endoscopic SBS on the clinical practice patterns of the American Rhinologic Society (ARS) membership.

A 23-item survey vetted by the ARS Board of Directors was electronically disseminated to the ARS membership from February 5, 2013, to March 31, 2013. The target group encompassed 982 ARS members.

A total of 152 physicians (15.5%) completed the survey. Open and endoscopic skull base procedures were performed by 41% and 94% of the respondents, respectively. During a typical year, the number of endoscopic skull base cases ranged from 0 to 20 in 56%, 21 to 50 in 26%, 51 to 100 in 9%, and >100 in 8%. Endoscopic cerebrospinal fluid (CSF) leak repair (96%) and transsphenoidal pituitary surgery (81%) were the most commonly performed procedures, followed by transcribriform (68.4%), transplanum (54.4%), and transclival (49.6%) approaches. Overall, 69.6% used endoscopy for resections of malignant sinus/skull base lesions. Considerable variation in Current Procedural Terminology (CPT) coding philosophy was observed, with open skull base (32%), unlisted endoscopic (29%), sinus surgery (24%), and unlisted neurosurgical (15%) codes employed by surgeons. Only 29% of physicians reported adequate reimbursement in ≥75% of cases. Eighty-five percent of respondents supported creation of dedicated endoscopic SBS codes.

This study illustrates the widespread integration of endoscopic SBS procedures into rhinologic clinical practice among survey respondents. However, current variability in coding strategies and inadequate reimbursement may warrant development of specific guidelines to standardize coding and billing processes in the future.