Otolaryngology Coding Alert

Question: Does a code exist that describes a midface degloving approach? The otolaryngologist's notes say, "Tumor excision/maxillectomy; inferior antrostomy."

Texas Subscriber

Answer: Otolaryngologists must remove the entire tumor in patients who have inverted papilloma, a tumor that spreads aggressively. A midface degloving approach consists of lifting the soft tissues from the midportion of the face of the skin, which allows unlimited exposure to the nasal cavities. The surgeon uses the technique, which omits visible scars, to gain access to the maxillary sinus. He or she then excises the tumor and performs a medial maxillectomy.

You should use 31225 (Maxillectomy; without orbital exenteration) to report the maxillectomy, which includes the facial incision. Physicians may employ other types of incisions, such as Weber-Ferguson, which you should report with 31255 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]). But midface degloving has the unique advantage of limited visible scarring, whereas Weber-Ferguson results in extensive midfacial scarring.

After the surgeon removes all sinus mucosa, he uses a skin graft to cover the exposed bone. You should report this graft separately. Select the code based on the type of graft, split (15120-15121) or full thickness (15260-15261), and the graft's size.

For the first 100 square centimeters of a split graft, report 15120 (Split graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or one percent of body area of infants and children [except 15050]). For each additional 100 square centimeters, assign add-on code +15121 ( each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof [list separately in addition to code for primary procedure]). For the first 20 square centimeters of a full thickness graft, report 15260 (Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less). For each additional 20 square centimeters, use +15261 ( each additional 20 sq cm [list separately in addition to code for primary procedure]).

Although the skin graft is separately reportable, you should not report the antrostomy. The National Correct Coding Initiative bundles 31020 (Sinusotomy, maxillary [antrotomy]; intranasal) into the more extensive 31225.