# Bilateral endoscopic APE and antrostomy



## sheilacpc (Jul 22, 2014)

Greetings,

Please share your opinions on which CPT code selection you would make for the following scenario.

Thanks,

Sheila

Select the CPT codes describing the following case: 
PREOPERATIVE DIAGNOSIS: Chronic sinusitis and nasal polyposis 
POSTOPERATIVE DIAGNOSIS: Same
OPERATIVE PROCEDURE: Bilateral endoscopic APE and antrostomy 
31255-50 
31255-50, 31256-50 
31200-50, 31256-50 
31267-50, 31255-50, 31256-50


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## jvargocpc (Jul 23, 2014)

Using 3M, I came up with 31255-50 and 31256-50. There is no NCCI edit stating they cannot be used together. 

Here's why: The code description for 31255 states ethmoidectomy, total (anterior and posterior) or the APE procedure.

The description for 31256 states an antrostomy is performed, but 31267 states that additionally the maxillary sinus may be opened and mucosa removed. 

With the limited information given, I wouldn't use 31267 in conjunction with 31255 and 31256.  

I wouldn't use 31200 because the APE procedure is specified and 31200 is anterior only. 

That's what I would pick from the options given. Hope it helps!


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## sheilacpc (Jul 25, 2014)

Thank you for your reply, it is greatly appreciated...

Here's the catch:  The definition for  "anstrostomy" means: "a surgical opening into an antrum, either through the medial wall into the nose or through the lateral wall into the oral cavity."

The description of the scenario does specifically state that  was the MAXILLARY antrum.   

Would it be assumptive coding to code 31256 and assume it is the maxillary antrum that was opened since there are other "antrums" in the nasal area?

Thanks again,

Sheila


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## jvargocpc (Jul 31, 2014)

You are absolutely right.

The best thing to do might be to query the provider and ask where the anstrostomy was performed since it isn't stated in the postop dx. I don't do a whole lot of ENT coding and 3M does have a tendency to lead you down a path you may not want if you don't know enough about the subject.

But I learned something new and that's what I love about coding - it's something new every day!


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