Otolaryngologists Increasingly Move Inferior Turbinate Surgery into the Office

The next consideration in calculating start-up costs is to determine which of the newer methods for performing ITH surgery you’ll be using. Two methods have gained traction in recent years and are used by most practitioners to reduce the soft tissue and underlying structures of enlarged turbinates and ease chronic congestion: radiofrequency ablation (RFA) and microdebridement. Both methods employ a power-source unit that must be purchased by the office-based practitioner in addition to disposable handpieces that attach to the power sources and can only be used for a single patient before being discarded.

Dr. Setzen said RFA or debridement units won’t add much to the cost of equipping an office for ITH surgery because many manufacturers will sell the units at a heavily discounted rate or even give them to an office at no charge. But they do charge for disposable handpieces. At about $100 per unit, those costs can quickly add up, he said. That’s why a firm understanding of how reimbursement works is so important in these endeavors. In a hospital, Dr. Setzen said, the surgeon and hospital are reimbursed not only for the ITH procedure, but also for the handpieces and other medical supplies used during the surgery. In the office setting, however, only the surgery itself is paid for. “We cannot bill for supplies or these handpieces, because payers have determined that all of those costs are built into the relative value of that office-based procedure,” he said. Moreover, the physician has to absorb those unreimbursed costs; they cannot be transferred to the patient via follow-up billing, he added.

Given these factors, is it really cost-effective for otolaryngologists to bring ITH surgery in-house? “It may take a few years to recoup your initial investment,” Dr. Setzen said. “But for me, the added convenience to the patient and the practice is well worth it.”

Other than cost, another reason some sinus surgeons balk at performing office-based surgery is the difficulty of untangling the sometimes arcane coding methods that payers require in order for the practice to get reimbursed the correct amount for a given procedure. “At first glance, it can be intimidating,” Dr. Setzen said. But by keeping a few key coding concepts in mind, most practices can steer clear of trouble, he said (see “Inferior Turbinate Surgery Coding Tips,” p. 9).

Patients Also Benefit

Peter Hwang, MD, professor of otolaryngology-head and neck surgery and chief of rhinology at the Stanford University Medical Center in California, is another proponent of office-based ITH surgery and has been teaching an AAO-HNS course on the procedure for more than a decade. He agreed with Dr. Setzen’s summary of the main benefits of the outpatient approach, including avoidance of general anesthesia, faster patient recovery and easier scheduling. He also stressed that there are major cost savings that will accrue to the patient as well. “Total charges to the patient will be significantly less, because nursing and anesthesia charges are avoided,” he said. Depending on a patient’s insurance coverage and deductibles, such charges can quickly add up, he added.