# Endoscopic removal of intranasal synechiae



## rgeib (May 11, 2017)

I'm trying to code the following procedure and I'm torn as to which way to go:

*Nasal Endoscopy *
*Type of Endoscope *Rigid
*Indication*: left intranasal synechiae
*Procedure*:  After verbal consent, the nose was anesthetized with topical oxymetazoline and 4% lidoocaine spray.  The endoscope was placed into the nasal cavity and findings are listed below:
*Turbinates* Small synechia noted from the left middle turbinate to the inferior aspect of the maxillary os.  This area was injected with 0.5mL of 1% lido with 1:100,000 epi.  A Freer elevator was used to divide the synechia.  The raw surface was lined with surgicell.  The left maxillary sinus was well aerated with no mucous or pus.
*Polyps* No polyps visible.
*Osteomeatal Complex *Open with no purulence, polyps, or scarring on the left side.
Septum Midline, no perforations.
*Nasopharynx* No significant adenoid enlargement or masses.

I know that lysis of intranasal synechia is 30560, but the use of the rigid endoscope suggests I should also add on 31231. However, I've also seen suggestions on procedures like this where only 31237 is advised since the maxillary Os is involved. Any advice would be appreciated. Thanks.


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## JenniferB7 (May 12, 2017)

Based on what you provided, I would code this as 31237.

Please remember that 31237 is for *Nasal*/Sinus Endoscopy, surgical; debridement.  Nasal endoscopy is covered under this code, not just sinus.

Furthermore, there is a CPT Assistant article (December 2011, pg. 13) that discusses CPT 31237.  It states that more frequent surgical sinus *debridement* may be indicated for the following clinical situations: "persistent crusting within the surgical bed, *adhesion formation* noted upon examination, more extensive surgery (eg, complex frontal sinusotomies, neoplasm resections), underlying immunologic disorders, diffuse polyposis, revision FESS, mucociliary disorders, allergic fungal sinusitis, and postoperative complications (eg, visual loss, cerebrospinal fluid leak)."  Based on that explanation, if you can report CPT 31237 for debridement of sinus adhesions, it is easily inferred that a nasal endoscopy for surgical treatment of nasal adhesions (or synechiae) would qualify as debridement for the purpose of reporting CPT 31237.

Hope that helps!


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## rgeib (May 12, 2017)

Great! I think that clears it up for me. Thanks for your help!


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## JenniferB7 (May 12, 2017)

You are very welcome!


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