Otolaryngology Coding Alert

Question: We performed an endoscopic lavage along with 31295 (Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium [e.g., balloon dilation], transnasal or via canine fossa) on the same side. Which code can we use to collect for the lavage?

Answer: Unfortunately, there is no code you can use for an endoscopic lavage, which typically involves irrigating water through the endoscope to clean the debris after the dilation. Although CPT^® includes codes for open lavage, your surgeon performed an endoscopic procedure, and the lavage is bundled into the dilation. Therefore, you can report 31295 for your claim but no other codes will apply to it.

As an aside, even during open procedures, you can’t typically bill a lavage code if the surgeon performs the lavage and the surgery on the same side. These codes (such as 31000, Lavage by cannulation; maxillary sinus [antrum puncture or natural ostium]) are bundled into the surgical procedures when performed on the same site. Most payers only allow you to separately report the open lavage code if it’s performed on the opposite side.