# Pterygopalatine Fossa Bx - Urgent



## terry4162 (Oct 21, 2015)

Good Afternoon - Hoping someone might be able to help with this I doubt it as I don't seem to find many people responding to head and neck questions.

Looking for code for pterygopalatine fossa bx. This was done as cosurgery with neurosurgeon. Patient has  left infratemporal fossa mass with a large intracranial extension. My ENT is using standard endoscopic instrumentation, performing a wide maxillary antrostomy from lacrimal crest to posterior wall of maxillary sinus and from the inferior turbinate inferiorly to the orbital floor superiorly. Exam of the maxillary sinus showed normal appearing mucosa, but bulging of the posterior wall of the maxillary sinus was rounded.. We could see the infraorbital nerve imprint behind the bone and this bulging was inferior and medial to it. The mucosa surface was burned and the pterygopalatine fossa was entered by removal of thinned posterior wall. Then the neurosurgeon entered the field for biopsy of the mass of the left pterygoplatine fossa. described in a separate note.

The surgery required the 2 surgeons with separate skills; one ENT endoscopic skull base surgeon and one neurosurgeon.

The ENT's portion was coded as 31040 and 31267, which I feel is totally inappropriate. I'm thinking this is an unlisted code due to endoscopic approach, but not sure what the code would be for the open technique for my NOC letter.

I would really appreciate any assistance in this matter.


----------



## nsteinhauser (Oct 23, 2015)

If this was done without endoscopic instrumentation, the 31040 would fit.  It says 'any approach' in the code - this may lead some to using it for endoscopic surgery - but based on all previous direction from CPT/AMA, you can't use the 'open' code for an endoscopic (or laparoscopic, for that matter) surgery.  
I would use a 30999 or 31299.  
People are willing to answer head and neck questions - have patience - but some questions don't have 'good answers' and take a lot of time/work.  Hope this helps.


----------

