Clarification on Reporting the Sinusectomy CPT Codes
Q. When a surgeon suctions purulent mucoid material from any of the sinuses, is this considered removal of tissue and reported with codes 31254/31255, 31267, or 31288? Is it appropriate to report sinusectomy codes when the surgeon is only suctioning the purulent mucous from the sinus?
A. If the physician performs nasal or sinus endoscopy and aspirates only purulent material from the area, which he or she examines, then only CPT code 31231-Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) should be reported. If there is endoscopic nasal/sinus debridement (ie, removal of necrotic material or tissue, not just suctioning mucus or pus), 31237-Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure) may be reported. Note that CPT codes 31254- Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) or 31255-with ethmoidectomy, total (anterior and posterior), 31267-with removal of tissue from maxillary sinus, or 31288- with removal of tissue from the sphenoid sinusall require that a sinusostomy or ethmoidectomy be performed. Suctioning of purulent material from sinuses during the performance of codes 31254/31255, 31267, or 31288 is, part of the procedure itself.
Approved January 2009
Important Disclaimer Notice (Updated 8/7/14)
CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.