Medical Necessity of Basal/Sinus Endoscopy-Surgical for Chronic Sinusitis

Required Medical Therapy Before Surgical Intervention

• The American Academy of Otolaryngology-Head and Neck Surgery recommends nasal saline irrigations to improve mucociliary clearance as part of medical management 3
• For chronic sinusitis, appropriate medical therapy must include ALL of the following before surgical intervention is considered: nasal corticosteroids and nasal saline irrigation 1, 2

Medical Necessity Criteria for Endoscopic Sinus Surgery

• Functional endoscopic sinus surgery (FESS) should be reserved for patients who do not satisfactorily respond to complete medical treatment 4
• Surgical intervention is only appropriate after failure of maximal medical therapy, which must include nasal saline irrigation 1, 2, 3

Common Pitfalls to Avoid

• Proceeding to surgical intervention before completing all required components of medical therapy may lead to unnecessary procedures 1, 2
• Overdiagnosis of sinusitis requiring surgical intervention is a concern in clinical practice 2
• Endoscopic examination is valuable in determining the need for surgical intervention, but should only be performed after complete medical therapy has failed 5, 6