Debridement of the sinus cavity is a procedure most commonly performed following endoscopic sinus surgery (ESS) and other nasal surgeries. It involves transnasal insertion of the endoscope for visualization and parallel insertion of various instruments for the purpose of removal of crusting (postsurgical or otherwise), residua of dissolvable spacers, coagulum, early synechiae, intranasal necrotic residue or devitalized bone or mucosa, all of which can facilitate scar formation. It may also be utilized to remove crusts or debris in patients with longstanding chronic sinus or nasal disease with persistent sinonasal inflammation who may have undergone sinus surgery in the past. It may, but not necessarily, is performed under topical, local or general anesthesia in a suitably equipped office or operating room, depending on the clinical circumstances of the case.
It is the position of the American Academy of Otolaryngology-Head and Neck Surgery that sinonasal debridement aids healing and optimizes the ability to achieve open, functional sinus and nasal cavities. This also facilitates optimal instillation of topical therapies and saline irrigations, long-term disease surveillance, and endoscopically derived cultures.
Similar improvement in control of inflammation and secondary infection is obtained by debridement in other subtypes of acute and chronic sinonasal patients; particularly in recurrent/persistent bacterial infections, fungal sinusitis and autoimmune processes. Debridement may also be required in patients with chronic crusting in the setting of previous endoscopic tumor surgery, endoscopic skull base surgery, illicit intranasal drug use and/or paranasal sinus radiation.
- The frequency with which the above mentioned procedure should be performed is determined by the patient’s disease severity, co-morbidities, patient intranasal care compliance, and wound healing. Successful management of the sinonasal debridement following ESS minimizes scar formation and improves the overall outcome of ESS, reducing the need for revision surgery due to scar formation. Under normal circumstances, 1-3 post-operative debridements are typical, but occasionally more debridements are needed due to disease severity, co-morbidity, or scar formation.
- There is little data on debridement after pediatric endoscopic sinus surgery, and a clinical consensus statement noted that postoperative debridement after ESS in pediatric patients is not essential for treatment success. However, there may be some utility in debridement in patients with co-existing lung disease, as this has shown to delay pulmonary exacerbations in pediatric patients with cystic fibrosis.
- The Medicare physician fee schedule assigns zero global days to the 31237 code and most ESS procedures (several have a 10-day period: 31239 and 31290-31294). Physician work and practice expense associated with endoscopic debridement (31237) is not included in the value of zero-day global ESS codes.
Medicare work values assigned to the various codes for ESS took into account all of these factors. assigning lower work-valued codes in the place of 31237, as well as with the Medicare global periods assigned, leads to the key elements which were arrived at to produce for the work done. This results in inconsistent reimbursement with the level, volume, and intensity of the work performed.
- Insurance companies which use Medicare approaches to reimbursements should use all of the critical elements of those formulations to be consistent with the work values and payment rules inherent in the Medicare concepts mentioned.
- Debridements performed after sinus surgery that included a concurrent septoplasty are reimbursable, as the debridement is used to keep the sinuses open and is a procedure performed for management of the sinonasal cavity and is independent of the management of the deviated septum with its associated 90-day global period
- Sinus surgery and sinus debridements are assigned unilateral work value. Payments for these procedures should also be based on laterality. Bilateral debridements should be billed and reimbursed as such.
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Bugten V, Nordgård S, Steinsvåg The effects of debridement after endoscopic sinus surgery. Laryngoscope. 2006 Nov;116(11):2037-43. doi: 10.1097/01.mlg.0000241362.06072.83. PMID: 17075402.
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Varsak YK, Yuca K, Eryılmaz MA, Arbag H. Single seventh day debridement compared to frequent debridement after endoscopic sinus surgery: a randomized controlled trial. Eur Arch Otorhinolaryngol. 2016 Mar;273(3):689-95. doi: 1007/s00405-015-3630-9. Epub 2015 Apr 23. PMID: 25903686.
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Shen SA, Jafari A, Qualliotine JR, DeConde AS. Follow-Up Adherence Is Associated with Outcomes After Endoscopic Sinus Surgery. Ann Otol Rhinol Laryngol. 2020 Jul;129(7):707-714. doi: 10.1177/0003489420908291. Epub 2020 Feb 20. PMID: 32079413.
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Tzelnick S, Alkan U, Leshno M, Hwang P, Soudry E. Sinonasal debridement versus no debridement for the postoperative care of patients undergoing endoscopic sinus surgery. Cochrane Database Syst Rev. 2018 Nov 8;11(11):CD011988. doi: 10.1002/14651858.CD011988.pub2. PMID: 30407624; PMCID: PMC6517168.
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Helmen ZA, Little RE, Robey T. Utility of Second-Look Endoscopy with Debridement After Pediatric Functional Endoscopic Sinus Surgery in Patients with Cystic Fibrosis. Ann Otol Rhinol Laryngol. 2020 Dec;129(12):1153-1162. doi: 10.1177/0003489420922865. Epub 2020 Jun 9. PMID: 32517494.
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Brietzke SE, Shin JJ, Choi S, Lee JT, Parikh SR, Pena M, Prager JD, Ramadan H, Veling M, Corigan M, Rosenfeld RM. Clinical Consensus Statement: Pediatric Chronic Rhinosinusitis. Otolaryngol Head Neck Surg. 2014 Oct;151(4):542-53. doi: 10.1177/0194599814549302. PMID: 25274375
Adopted 8/5/1999
Revised 12/8/2012
Revised 4/13/2021
Revised 5/13/2025
Important Disclaimer Notice (Updated 7/31/14)
Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.
